Impact of Neuraxial Labor Analgesia on Newborn Safety Markers: A Report from No Pain Labor N' Delivery in China

Abstract Number: F 6
Abstract Type: Original Research

Ling Qun Hu MD1 ; Qingquan Lian MD, PhD2; Mingpin Hu MD, BS3; Weike Tao MD4; Pamela Dru Flood MD, MA5; Tony Chang MD6
Northwestern University1 ; The Second Hospital of Wenzhou Medical College 2; The Second Hospital of Wenzhou Medical College 3; University of Texas Southwestern Medical Center4; University of California at San Francisco5; University of California at San Francisco6

Introduction: There are no large-scale studies focusing on newborn outcomes directly related to initiating neuraxial labor analgesia (NA) in China. No Pain Labor N' Delivery (NPLD) was launched in Wenzhou China in 2010. The barrier put forward by the Chinese community was whether their resources could support safe provision of newborn care after NA. The aim of this study is to evaluate the impact of the implementation of NA on newborn safety outcomes in a single academic hospital.
Methods: Data were collected by medical record review and several pre-existing databases at the Second Hospital of Wenzhou Medical College in 01/2009-06/2011. A part time obstetric anesthesia service (0800-1700 on weekdays) was established on 05/29/2009 and became 24/7 on 05/03/2010. NPLD was conducted on June 2010. The epidural protocol modified from current practices at Northwestern University consisted of levobupivacaine 0.0625% + sufentanil 0.1-0.2μg/mL, initial bolus 20 mL, continuous infusion 10mL/h with optional manual bolus (5-10mL per), used only in the first stage of labor. No other analgesics were available. Patients deemed high risk were delivered via cesarean delivery (CD). The study period was divided into three phases: baseline (01/2009-06/2009, NA=0%), phase-in (07/2009-05/2010), and post-NPLD (06/2010-06/2011, NA>50%). Outcome variables include naloxone administration, NICU admission (NICUa), NICU length of stay, average 1 and 5 minute Apgar scores for newborns admitted to NICU, incidence of Apgar scores <3 and <7 at 5 minutes, intrauterine fetal death, and 7 day infant mortality. Vaginal and cesarean deliveries were analyzed separately. The Baseline and post-NPLD phases were compared with t-tests. Statistical significance was considered at p < 0.01.
Results: The NA rate increased from 0% to 57% after the NPLD intervention (see figure) during a course of 15,415 deliveries. A summary of results is shown in the table. A significant decrease in the rate of naloxone administration (-0.61%) after vaginal delivery while NICUa following CD increased from 13.7% to 20.3% occurred following NPLD but overall NICUa was not altered.
Conclusion: Although the etiology of the increase in NICU admissions born via CD is unclear, the overall NICU admission rate was unchanged. The naloxone usage reduction seems clinically insignificant. Our data suggests that the implementation of NA in the first stage of labor in this community is safe to newborns.

SOAP 2013