Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study.

BACKGROUND: Maternal intrapartum fever (MF) is associated with neonatal sequelae, and women in labour who receive epidural analgesia (EA) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. METHODS: Population-based register study with data from the Swedish Birth Register and the Swedish National Patient Register, including all nulliparae (n=294,329) with singleton pregnancies who gave birth at term in Sweden 1999-2008. Neonatal outcomes analysed were Apgar score (AS)<7 at 5 min and ICD-10 diagnosis of neonatal encephalopathy (e.g. convulsions or neonatal cerebral ischaemia). Multivariate logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS: EA was used in 44% of the deliveries. Low AS or encephalopathy was found in 1.26% and 0.39% of the children in the EA group compared with 0.80% and 0.29% in the control group. In multivariate analysis, EA was associated with increased risk with low AS, AOR 1.27 (95% CI 1.16-1.39), but not with diagnosis of encephalopathy, 1.11 (0.96-1.29). A diagnosis of MF was associated with increased risk for both low AS, 2.27 (1.71-3.02), and of neonatal encephalopathy, 1.97 (1.19-3.26). CONCLUSION: Diagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry-based population study.

[Neonatal nonbacterial thrombotic endocarditis]. / Endocarditis nobacteriana trombótica neonatal.

A case of neonatal nonbacterial thrombotic endocarditis confirmed at autopsy was identified in the neonatal intensive care unit. The infant suffered from hyaline membrane and disseminated intravascular coagulation. A degenerative verrucal endocarditis at the tricuspid and aortic valves was demonstrated in addition to pulmonary and renal embolism. Vegetations on the heart valves of the newborn infants are rare at necropsy and yet to be diagnosed antemortem. Prospective studies are needed to determine whether high-risk patients should be screened periodically by echocardiographic technique.