Epidural analgesia and neonatal fever.

To the Editor. We read with interest the report of Lieberman et al1 regarding the relationship of the duration of epidural analgesia and fever in labor. We have had a long-held hypothesis regarding this relationship based on both the study of Fusi et al2 in 1989 and a retrospective study we performed and presented as a poster at the Society for Pediatric Research in 1990.3 Our prior study closely agrees with the conclusions in the Lieberman study. We analyzed computerized data on all 1909 infants admitted to the special care nurseries for a 30-month period, delivered by our obstetrical service with 60% epidural use. Fever in labor was found in 32% of the mothers with epidurals and in 12.5% of the mothers not given epidurals (χ2 94.11, P < .00001). Mothers with epidurals who had fever were given antibiotics more often ( P < .05), and term infants born to mothers with epidural and fever received significantly more lab tests and antibiotics ( P < .001) without any increase in culture-proven sepsis. Also, the length of stay for these latter infants averaged 6.7 days, compared with 3.0 days for children born to mothers who remained afebrile after epidural. Because our standard practice was to admit all infants of mothers with fever to the special care nurseries, the incidence of fever in the 8400 live births (all levels of gravidarity) was calculated as 5.7% with an incidence of approximately 2.5% in those without epidurals and 7.5% of those with epidural analgesia.3 These numbers, although less dramatic than the 1% and 14.5% found by Lieberman et al1 in their population of 1657 primigravidas, confirm the strong correlation of fever and epidural analgesia. Lieberman et al1 also concluded that there were more sepsis evaluations and antibiotic use in …