NEW YORK, March 11 (Reuters) -- Epidural, or a spinal block anesthesia can ease the pains of childbirth, but may also cause a fever in the mother-to-be, a new study suggests. While the fever isn't harmful to the woman, it can cause a newborn to undergo unnecessary testing and treatment for nonexistent bacterial infections -- which also can cause a fever.
About 14% of women with epidurals had a fever that went above 100.4 degrees Fahrenheit, compared with just 1% of women who didn't have spinal block anesthesia, according to a report in the journal Pediatrics.
The children in the epidural group were four times as likely as others to be tested for a bacterial infection or to be given antibiotics. In the group of children whose mothers were given an epidural -- an anesthetic injection into the space surrounding the spinal cord -- 34% were tested for an infection and 15% were given antibiotics. In children whose mothers did not have the anesthesia, about 10% were tested for infections and 4% given antibiotics.
Of the 416 infants that were tested, only four infants -- three from the epidural group -- did, indeed, have a bacterial infection that needed treatment.
Such treatments are not benign, noted lead study author Dr. Ellice Lieberman, of the obstetrics and gynecology department at Brigham and Women's Hospital and Harvard Medical School in Boston. While infants are given a combination of relatively safe antibiotics, ampicillin and gentamycin, at higher doses such drugs can have toxic side effects on the kidneys and ears.
"In addition, parents may be affected psychologically when their newborn is admitted to the intensive care unit for tests and spends a minimum of 48 hours receiving intravenous medication," she wrote. "Finally, evaluation and treatment of these infants uses substantial additional health care resources, particularly if antibiotic treatment extends neonatal hospital stay."
The results indicate that women should be informed of the fever risk when choosing anesthesia during childbirth, and that the criteria used to test a newborn for infection should be re-examined. Possibly, only very high fevers in a woman with an epidural would warrant testing an infant, according to the report.
"Given the cost, risk and pain to the newborns, the high proportion of (infection) work-ups that may be attributable to epidural use is cause for concern," the authors concluded.
SOURCE: Pediatrics (1997;99:415-419)
