The premature infant: anesthesia for cesarean delivery
Rolbin, S.H.; Cohen, M.M.; Levinton, C.M.; Kelly, E.N.; Farine, D.
Anesthesia and Analgesia 78(5): 912-917
1994
ISSN/ISBN: 0003-2999 PMID: 8160989 Document Number: 428075
The influence of anesthetic technique (general (GA) versus epidural (EPI)) on neonatal outcome was assessed for singleton infants of gestational age 32 wk or less, delivered by cesarean section. Neonates were identified from a prospectively collected perinatal database from 1986 to 1991. The independent effect of anesthetic technique on low 1-min Apgar scores after controlling for other risk factors was assessed by ordinal logistic regression. Among the 509 infants studied, 30% had Apgar scores of 0 to 3 at 1 min and 5.9% at 5 min. Among infants delivered with GA, 46.4% had low 1-min and 10.1% had low 5-min Apgar scores as compared to 22.0% and 3.8% for EPI. GA as compared to EPI was associated with higher risk of low (0-3) 1-min score after controlling for confounding factors (relative odds = 2.92, (1.99, 4.27 95% confidence intervals)). Other factors significantly related to low 1-min Apgar scores included malpresentation, maternal diabetes, primiparity, low gestational age, and associated neonatal outcomes (presence of respiratory distress syndrome and intraventricular hemorrhage). When there is a choice to be made in cesarean delivery of the premature infant, EPI is associated with higher 1- and 5-min Apgar scores compared to GA.