Potential impact of epidural labor analgesia on the outcomes of neonates and children

Abstract

This review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including “ELA,” “ELA and neonatal outcomes,” “ELA and children's development,” and “ELA and children's neurocognitive development” were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children's neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children's outcomes need to be studied further.

Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally

“…Epidural analgesia provides effective relief of labor pain, but the associations between epidural analgesia and maternal and neonatal morbidity are controversial. 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 The risk of maternal fever is 4-fold higher in women receiving epidural analgesia, 10 , 11 , 12 , 13 but the associations of neonatal outcomes with epidural analgesia–associated maternal fever vary. 14 , 15 , 16 In addition, placental infection, like histologic chorioamnionitis, is associated with epidural analgesia use and may cause intrauterine infection.…”

“…Epidural analgesia provides effective relief of labor pain, but the associations between epidural analgesia and maternal and neonatal morbidity are controversial . The risk of maternal fever is 4-fold higher in women receiving epidural analgesia, but the associations of neonatal outcomes with epidural analgesia–associated maternal fever vary .…”