Analysis of the interaction between the moment of fever during labor and the peak of fever in parturients with epidural analgesia and adverse neonatal outcome

doi:10.11958/20253174

Abstract

Abstract:

Objective To explore the interaction between the time of intrapartum fever and the peak of fever in parturients with epidural analgesia and adverse neonatal outcome. Methods A total of 118 parturients with fever during labor who received epidural analgesia were included. A statistical analysis was conducted to investigate the occurrence of neonatal adverse outcomes. Logistic regression modeling was utilized to assess the independent association of intrapartum fever onset timing and peak fever magnitude with neonatal adverse outcomes, along with their potential interaction effects. Threshold effect analyse for intrapartum fever timing and peak temperature were performed using restricted cubic splines through the rms package in R version 3.6.1, generating smoothed fitting curves to visualize these relationships. Results The incidence of adverse neonatal outcome in parturients with fever during labor due to epidural analgesia was 36.44%. Older age, gestational diabetes and peak fever were all independent risk factors for adverse neonatal outcome, while later timing of intrapartum fever was a protective factor (P < 0.05). When the duration of fever during labor was shorter than 7.9 hours, the incidence of adverse neonatal outcome decreased with the delay of the duration of fever during labor. When the peak fever was higher than 38 ℃, the incidence of adverse neonatal outcome increased with the increase of the peak fever. There was a negative additive interaction between the moment of fever during labor and the peak of fever on adverse neonatal outcome. Among the adverse neonatal outcomes where the moment of fever during labor and the peak of fever coexist, 39.8% was caused by the interaction between the two. Conclusion The time and peak of fever during labor in parturients with epidural analgesia have a negative additive interaction effect on adverse neonatal outcome.

Key words: analgesia, epidural, parturition, fever, infant, newborn, the moment of fever during labor, peak fever, adverse outcomes of newborns

CLC Number:

R714，R614

Figures/Tables 4

References 28

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组别		n	年龄/岁		孕前体质量指数/（kg/m²）			产妇类型			孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
组别		n	年龄/岁		孕前体质量指数/（kg/m²）			初产妇		经产妇	孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
正常组		75	31.99±3.10		23.49±2.59			56（74.67）		19（25.33）	39.42±1.05		13（17.33）		8（10.67）		65（86.67）		38（50.67）
不良组		43	33.26±3.05		23.62±2.75			30（69.77）		13（30.23）	39.37±1.02		7（16.28）		13（30.23）		38（88.37）		24（55.81）
t或χ²			2.154^＊		0.257			0.332			0.252		0.022		7.152^＊＊		0.072		0.290
组别	使用抗生素			产程/h					产时发热情况							新生儿性别（男/女）		新生儿体质量/kg
组别	使用抗生素			第一产程		第二产程	第三产程		产时发热时刻/h			发热峰值/℃		发热持续时间/h		新生儿性别（男/女）		新生儿体质量/kg
正常组	65			12.83±3.78		0.50±0.20	0.17±0.06		8.09±0.76			37.93±0.20		1.34±0.25		38/37		3.30±0.29
不良组	37			13.02±3.91		0.52±0.19	0.18±0.05		7.51±0.80			38.12±0.22		1.37±0.26		23/20		3.27±0.31
t或χ²	0.009			0.260		0.532	0.924		3.914^＊＊			4.788^＊＊		0.618		0.087		0.527

组别		n	年龄/岁		孕前体质量指数/（kg/m²）			产妇类型			孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
组别		n	年龄/岁		孕前体质量指数/（kg/m²）			初产妇		经产妇	孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
正常组		75	31.99±3.10		23.49±2.59			56（74.67）		19（25.33）	39.42±1.05		13（17.33）		8（10.67）		65（86.67）		38（50.67）
不良组		43	33.26±3.05		23.62±2.75			30（69.77）		13（30.23）	39.37±1.02		7（16.28）		13（30.23）		38（88.37）		24（55.81）
t或χ²			2.154^＊		0.257			0.332			0.252		0.022		7.152^＊＊		0.072		0.290
组别	使用抗生素			产程/h					产时发热情况							新生儿性别（男/女）		新生儿体质量/kg
组别	使用抗生素			第一产程		第二产程	第三产程		产时发热时刻/h			发热峰值/℃		发热持续时间/h		新生儿性别（男/女）		新生儿体质量/kg
正常组	65			12.83±3.78		0.50±0.20	0.17±0.06		8.09±0.76			37.93±0.20		1.34±0.25		38/37		3.30±0.29
不良组	37			13.02±3.91		0.52±0.19	0.18±0.05		7.51±0.80			38.12±0.22		1.37±0.26		23/20		3.27±0.31
t或χ²	0.009			0.260		0.532	0.924		3.914^＊＊			4.788^＊＊		0.618		0.087		0.527

变量	β	SE	Wald χ²	P	OR （95%CI）
年龄	0.156	0.075	4.312	0.038	1.169（1.009~1.354）
妊娠期糖尿病	1.322	0.571	5.365	0.021	3.749（1.225~11.471）
产时发热时刻	-0.547	0.211	6.705	0.010	0.578（0.382~0.875）
发热峰值	0.680	0.238	8.153	0.004	1.975（1.238~3.151）
常数项	-7.247	6.920	8.666	0.003	0.002

变量	β	SE	Wald χ²	P	OR （95%CI）
年龄	0.156	0.075	4.312	0.038	1.169（1.009~1.354）
妊娠期糖尿病	1.322	0.571	5.365	0.021	3.749（1.225~11.471）
产时发热时刻	-0.547	0.211	6.705	0.010	0.578（0.382~0.875）
发热峰值	0.680	0.238	8.153	0.004	1.975（1.238~3.151）
常数项	-7.247	6.920	8.666	0.003	0.002

临床表现	总例数	不良结局例数	正常结局例数	OR（95%CI）	P
产时发热时刻（-）/发热峰值（-）	30	11	19	1
产时发热时刻（-）/发热峰值（+）	25	13	12	1.870（1.005~3.480）	<0.001
产时发热时刻（+）/发热峰值（-）	33	7	26	0.465（0.251~0.861）	<0.001
产时发热时刻（+）/发热峰值（+）	30	12	18	1.152（0.497~2.672）	>0.05