Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever

Goetzl, Laura; Evans, Tracy; Rivers, Jose; Suresh, S.; Lieberman, Ellice

doi:10.1067/mob.2002.127135

Cited by 128 publications

(108 citation statements)

References 15 publications

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“…Maternal fever has been associated with epidural analgesia and with an elevation in maternal and fetal cytokines. [35][36][37] However, it appears that the inflammatory response originates from the mother rather than the infant. Maternal fever is often considered to indicate chorioamnionitis, but without our ability to have histologic evidence of chorioamnionitis, infection by these criteria may have been overestimated, and, if no infection was present, would weaken the association.…”

Section: Discussionmentioning

confidence: 99%

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

et al. 2004

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We tested the hypothesis that term and preterm infants exposed to maternal infection at the time of delivery are at increased risk of developing cerebral palsy (CP). STUDY DESIGN:A population-based case-control study was conducted using Washington State birth certificate data linked to hospital discharge data. Cases (688) were children r6 years old, singleton births, hospitalized during 1987 to 1999 with an ICD-9 diagnosis code for CP. Controls were 3068 singleton birth infants randomly selected from birth records for the same years without CP-related hospitalizations. Infection information was available only for the birth hospitalization. RESULTS:Infants of women who had any infection during their hospitalization for delivery were at increased risk of CP (odds ratio (OR) 3.1, 95% confidence interval (CI) 2.3 to 4.2). This was observed for term deliveries (OR 1.8, 95% CI 1.1 to 2.8) and preterm deliveries (OR 2.3, 95% CI 1.3 to 4.2). CONCLUSIONS:Our results suggest that maternal infection is a risk factor for CP in both term and preterm infants.

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Section: Discussionmentioning

confidence: 99%

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

et al. 2004

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“…[19][20][21][22] It is unclear whether hyperthermia itself causes brain injury or whether other factors (eg, infection, systemic inflammation) cause both a raised temperature and brain injury. 2,23,24 In term animals, hyperthermia appears to increase neuronal cell damage in those at risk for perinatal hypoxiaischemia. 25 In addition, hyperthermia during ventilation of preterm newborn lambs exacerbates lung injury.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Exothermic Mattresses for Preterm Newborns in Polyethylene Bags

et al. 2013

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BACKGROUND AND OBJECTIVE: Hypothermia on admission to the NICU is associated with increased mortality in preterm infants. Many newborns are hypothermic on admission despite using polyethylene bags (PBs). Using exothermic mattresses (EMs) in addition to PBs may reduce hypothermia but increase hyperthermia. We wished to determine whether placing preterm newborns in PBs on EMs in the DR results in more infants with rectal temperature outside the range 36.5 to 37.5°C on NICU admission. METHODS: Infants <31 weeks were randomly assigned before birth to treatment with or without an EM. All infants were placed in a PB and under radiant heat immediately after birth and brought to NICU in a transport incubator. Infants randomly assigned to EM were placed on a mattress immediately after delivery and remained on it until admission. Randomization was stratified by gestational age. Rectal temperature was measured with a digital thermometer on NICU admission. RESULTS: The data safety monitoring committee recommended stopping for efficacy after analyzing data from half the planned sample. We report data for 72 infants enrolled at this time. Fewer infants in PBs on EMs had temperatures within the target range (15/37 [41%] vs 27/35 [77%], P = .002) and more had temperatures >37.5°C (17/37 [46%] vs 6/35 [17%], P = .009). CONCLUSIONS: In very preterm newborns, using EMs in addition to PBs in the DR resulted in more infants with temperatures outside the normal range and more hyperthermia on NICU admission.

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“…12 De Jongh et al 13 have also reported a relationship between epidural analgesia and increased maternal levels of IL-6. The mechanism through which epidural analgesia may trigger cytokine production during labor is not clear.…”

Section: Commentmentioning

confidence: 99%

Prophylactic Acetaminophen Does Not Prevent Epidural Fever in Nulliparous Women: A Double-Blind Placebo-Controlled Trial

et al. 2004

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OBJECTIVE:Epidural analgesia is associated with a four-to five-fold increase in noninfectious maternal fever in nulliparous women. Fever prophylaxis may safely reduce both unnecessary neonatal sepsis evaluations and the potential effect of fever on the fetus. STUDY DESIGN:We performed a randomized double-blind placebo-controlled study. Immediately after epidural placement, full-term nulliparas with a temperature of <99.51F received acetaminophen 650 mg or placebo, per rectum, every 4 hours. Tympanic membrane temperatures were measured hourly. Our power to detect an effect of acetaminophen treatment on maternal temperature over time was 90%. RESULTS:In all, 21 subjects were randomized to each arm. Treatment with acetaminophen did not impact maternal temperature curves. Fever >100.41F was identical in the acetaminophen and placebo groups (23.8%, p ¼ 1.0). Neonatal surveillance blood cultures did not reveal occult infection. CONCLUSIONS:Acetaminophen prophylaxis prevented neither maternal hyperthermia nor fever secondary to epidural analgesia, suggesting that the mechanism underlying fever does not include centrally mediated perturbations of maternal thermoregulation.

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Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever

Cited by 128 publications

References 15 publications

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

Maternal Infection and Risk of Cerebral Palsy in Term and Preterm Infants

A Randomized Trial of Exothermic Mattresses for Preterm Newborns in Polyethylene Bags

Prophylactic Acetaminophen Does Not Prevent Epidural Fever in Nulliparous Women: A Double-Blind Placebo-Controlled Trial

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