Labor epidural analgesia is independent risk factor for neonatal pyrexia

OBJECTIVE: To explore whether epidural analgesia (EA) in labor is independent risk factor for neonatal pyrexia after controlling for intrapartum pyrexia. METHODS: Retrospective observational study of 480 consecutive term singleton infants born to mothers who received EA in labor (EA group) and 480 term infants delivered to mothers who did not receive EA (NEA group). RESULTS: Mothers in the EA group had significantly higher incidence of intrapartum pyrexia [54/480 (11%) vs. 4/480 (0.8%), OR = 15.1, p < 0.0001] and neonatal pyrexia [68/480 (14.2%) vs. 15/480 (3.1%), OR = 5.1, p < 0.0001]. Neonates in the EA group had a median duration of pyrexia of 1 h (maximum 5 h) with a peak temperature within 1 h. Stepwise logistic regression analysis showed that maternal EA was independent risk factor for neonatal pyrexia (>37.5°C) after controlling for intrapartum pyrexia (>37.9°C) and other confounders (OR = 3.44, CI = 1.9-6.3, p < 0.0001). Sepsis work-up was performed significantly more frequently in infants in the EA group [11.7% vs. 2.5%, OR= 5.2, CI = 2.7-9.7, p < 0.0001] with negative blood cultures. CONCLUSIONS: EA in labor is an independent risk factor for pyrexia in term neonates. It is unnecessary to investigate febrile offspring of mothers who have had epidurals unless pyrexia persists for longer than 5 h or other signs or risk factors for neonatal sepsis are present.