Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity

Figures & data

Figure 1 Flow chart: exclusion process.

Table 1 Baseline Maternal and Neonatal Characteristics

	Epidural =1490	Non-Epidural =870	Mean Difference (95% CI)	Odds Ratio (95% CI)	P-Value
Mother’s age-Years (SD)	26.42 (4.20)	26.51 (4.60)	−0.093 (−0.46 to 0.27)		0.62
Gestational age-Weeks (SD)	39.36 (1.30)	39.17 (1.05)	0.61 (0.94 to 0.29)		<0.001
Induced labor No. (%)	239 (16)	117 (13.4)		1.23 (0.96 to 1.56)	0.09
Gestational diabetes No. (%)	327 (21.90)	202 (23.2)		0.93 (0.76 to 1.13)	0.47
Male No. (%)	744 (49.90)	418 (48)		0.92 (0.78 to 1.09)	0.37
Female No. (%)	746 (50.10)	452 (52)
Birth weight-Kg (SD)	3.276 (0.34)	3.186 (0.346)	0.089 (0.06 to 0.11)		<0.001

Abbreviations: SD, standard deviation; No(%), number(percentage).

Table 2 Maternal Outcomes in EA

	Epidural=1490	Non-Epidural=870	Mean Difference (95% CI)	Odds Ratio (95% CI)	P Value
Duration of second stage of labor-in Minutes (SD)	94.5 (75.3) (recorded in 565 cases)	45.1 (47.5) (recorded in 342 cases)	49.36 (40.45 to 58.28)		<0.001
Peak maternal temp during labor (SD)	37.04 (0.38) recorded in 1456	36.92 (0.27) recorded in 863	0.12 (0.09 to 0.14)		<0.001
Peak maternal temp during labor >37.5°C No. (%)	127 (8.7)	11(1.3)		7.40 (3.93 to 13.69)	<0.001
Meconium stained amniotic fluid No.(%)	282 (18.9)	131 (15.1)		1.31 (1.05 to 1.62)	0.01
Fetal distress No. (%)	374 (25.1)	150 (17.2)		1.60 (1.30 to 1.98)	<0.001
LSCS No.(%)	340 (22.8)	193 (22.2)		1.03 (0.84 to 1.26)	0.72
Instrumental delivery No. (%)	360 (24.2)	113 (13)		2.13 (1.69 to 2.68)	<0.001

Abbreviations: SD, standard deviation; No(%), number(percentage).

Table 3 Perinatal Outcome

	Epidural=1490	Non–Epidural =870	Mean Difference (95% CI)	Odds Ratio (95% CI)	P Value
Cord arterial pH-pH (SD)	7.235 (0.089) Done in 521	7.239 (0.096) Done in 224	−0.003 (−0.018 to 0.01)		0.61
Cord arterial pH <7.1 No. (%)	36 (6.9) Done in 521	17 (7.6) Done in 224		0.90 (0.49 to 1.64)	0.75
1-minute Apgar (SD)	8.851 0.77	8.906 (0.63)	−0.054 (−0.115 to 0.006)		0.07
1-minuteApgar<7. No. (%)	32 (2.1)	11 (1.3)		1.71 (0.85 to 3.41)	0.12
5-minute Apgar (SD)	9.97 0.23	9.97 0.39	0.00 (−0.026 to 0.025)		0.97
Birth injury No. (%)	69 (4.6)	24 (2.8)		1.71 (1.06 to 2.74)	0.02
Positive pressure ventilation at birth No. (%)	69 (4.6)	26 (3)		1.57 (0.99 to 2.49)	0.05

Abbreviations: SD, standard deviation; No(%), number(percentage).

Table 4 Effect of Epidural Analgesia on Neonatal Clinical Parameters

	Epidural=1490	Non-Epidural =870	Mean Difference (95% CI)	Odds Ratio (95% CI)	P Value
NICU admission No. (%)	245 (16.4)	82 (9.4)		1.89 (1.45 to 2.46)	<0.001
NICU admission when maternal temperature 37° C or less	181(13.6) Total −1329	73(8.6) Total −852		1.68(1.26–2.24)	<0.001
NICU stay duration–days (SD)	3.11 (2.08) Done in 245/245	2.91 (3.17) Done in 82/82	0.19 (−0.40 to 0.80)		0.51
Admissions due to suspected maternal chorioamnionitis No.(%)	98 (6.6)	14 (1.6)		4.30 (2.44 to 7.58)	<0.001
Temperature upon NICU admission- °C (SD)	37.05 (0.42) Done in 245/245	36.89 (0.45) Done in 82/82	0.159 (0.05 to 0.26)		<0.01
Temperature upon NICU admission >37.5°C No. (%)	28 (11.4) Recorded in 245/245	3 (3.7) Recorded in 82/82		3.40 (1.00 to 11.49)	0.04
Respiratory distress No. (%)	134 (9)	54 (6.2)		1.49 (1.07 to 2.07)	0.01
Admission for post resuscitation care No. (%)	34 (2.3)	13 (1.5)		1.53 (0.80 to 2.93)	0.22
Need for any respiratory support No. (%)	109 (7.3)	45 (5.2)		1.44 (1.01 to 2.07)	0.04
Mechanical ventilation No. (%)	6(0.4)	6(0.1)		0.58 (0.18–1.81)	0.37
Antibiotic started on day 1 No. (%)	137 (11.6)	53 (6.1)		2.06 (1.47 to 2.79)	<0.001
Antibiotic duration-5 days or more No.(%)	21 (1.4)	1(0.1)		12.42 (1.66–92.55)	0.01
Transient tachypnea No. (%)	71 (4.8)	39 (4.5)		1.06 (0.71 to 1.59)	0.75

Abbreviations: SD, standard deviation; No(%), number(percentage).

Table 5 Effect of Epidural Analgesia on Neonatal Lab Parameters (Done in the Patients Who Needed NICU Admission)

	Epidural=1490 (Admitted=245)	Non–Epidural =870 (Admitted=82)	Mean Difference (95% CI)	Odds Ratio (95% CI)	P Value
C Reactive protein- max (SD)	16.04 (21.98) Done in 123/245	18.4 (31.96) Done in 35/82	−2.35 (−11.63 to 6.91)		0.61
C Reactive protein max >10 No. (%)	50 (40.7) Done in 123/245	13 (37.1) Done on 35/82		1.15 (0.53 to 2.51)	0.84
Leukocyte count × 10^6(SD)	18.24 (5.04) Done in 201/245	18.99 (6.42) Done in 68/82	−0.75 (−2.25 to 0.74)		0.32
Platelet count ×10^6(SD)	247.66 (62.46) Done in 200/245	255.46 (68.53) Done in 69/82	−7.8 (−25.4 to 9.8)		0.38

Abbreviations: SD, standard deviation; No(%), number(percentage).