Labour epidural analgesia and anti-infectious management of the neonate: a meta-analysis

Background: A known side effect of labour epidural analgesia (EDA) is maternal fever. It is unclear whether this has effects on the anti-infectious management of the neonate. Methods: A systematic literature search and a hand search of abstract publications were conducted. Studies reporting sepsis evaluation or antibiotic treatment were further assessed. For meta-analysis, risk ratio (RR) and 95% confidence interval (CI) were calculated using the random effects model. Results: Five relevant articles reporting on 4667 parturients were identified; three were observational studies and two were randomised controlled trials (RCT). The RR for sepsis workup of all studies analysed together was 2.58 (95% CI, 1.06–6.27, P=0.04). The RR for antibiotic treatment of the neonate was 2.76 (95% CI, 1.20–6.31, P=0.02). When considering the RCTs alone, the RRs for sepsis evaluation and antimicrobial treatment were still significantly elevated. Discussion: Our data suggest that EDA-related maternal hyperthermia results in an increased likelihood of sepsis workup and antibiotic treatment of the infant. A crucial question is whether EDA-related maternal hyperthermia is truly infectious. If not, administration of antibiotics would not be justified and may be dangerous.