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Intrapartum Fever and Seizures
Intrapartum Fever and Unexplained Seizures in Term Infants. Lieberman E, Eichenwald E, Mathur G, et al. Pediatrics 2000; 106 : 983-88.
In order to investigate a possible association between noninfectious intrapartum fever and neonatal seizures, the authors conducted a case-control study. The case group consisted of all term infants with unexplained seizures after a trial of labor born at Brighan andWomen’s Hospital between 1989 and 1996 (n = 38). Four controls matched by parity and date of birth were identified for each case. The rate of intrapartum maternal fever (T > 100.4o F) was compared for case and control infants. Infants with seizures were more likely to be born to mothers who were febrile during labor (31.6% vs 9.2%; p = .001). In a logistic regression analysis controlling for confounding factors, intrapartum fever was associated with a 3.4-fold increase in the risk of unexplained neonatal seizures.
Comment. This study follows up on an earlier report by Drs. Lieberman et al (Pediatrics 2000; 105:8-13. Reviewed in article 1-003 of this publication) that identified an association between noninfectious intrapartum maternal fever and lower 1-minute Apgar scores, need for neonatal resuscitation, hypotonia after birth, and need for oxygen therapy in the nursery. That study identified 4 infants with unexplained neonatal seizures after intrapartum fever. The present study confirms the association using a much larger sample size. While the physiologic mechanism for this association remains uncertain, the authors speculate that it could reflect an effect of cytokines (known to be increased at delivery after epidural anesthesia), or of an increased metabolic rate that exacerbates the effects of fetal hypoxia.
Andrew B. Kairalla MD