Anesthesia for cesarean delivery in very preterm infants
Abstract Number: 187
Abstract Type: Original Research
Introduction: Spinal anesthesia (SA) for cesarean delivery (CD) has been associated with potentially harmful neonatal effects when compared to epidural and general anesthesia (GA).(1) Most data are from studies of elective CD in term infants. Little is known of the effect on outcome in premature infants; a recent retrospective study suggested an association between increased neonatal mortality and SA when compared to GA.(2)
Method: Case notes of women who underwent CD at <33 weeks of gestation from 2004-08 in our unit were reviewed. Data on maternal and fetal morbidity, anesthetic technique and neonatal outcome were collected. SA and GA were compared using a multivariate regression model to control for maternal and fetal factors that could influence outcome.
Results: 238 CD were identified of which 186 case notes were available. There were 37 twin deliveries giving a total of 223 infants. SA was used in 146 cases, GA in 40 and epidural in 4. Epidurals were excluded from further analysis. There were no significant differences in maternal age, gestational age or birthweight between GA and SA. Use of GA was more likely where maternal complications (e.g. APH, eclampsia, chorioamnionitis) were present. Results of univariate analysis are shown in the table.
Following regression analysis of outcome variables controlling for maternal and fetal factors, 1-min Apgar score was less in the GA group compared to the SA group (0.992; P=0.018); 5-min Apgar score was 0.85 less in the GA group (P=0.004). Venous pH was lower in the GA group by 0.045 (P=0.03). Length of stay in SCBU was increased in the GA group by 9.3 days compared to the SA group (P=0.032).
Discussion: GA was predictably associated with lower Apgar scores. Unlike previous work, we did not observe a harmful association between SA and neonatal outcome. We found length of stay in SCBU to be increased by >7 days where GA was used and that GA was used more often where maternal complications were present. Further investigation is required to determine the nature of this association between GA and fetal morbidity.
1 Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia 2005; 60: 636 -53.
2 Laudenbach V, Mercier FJ, Roze J-C et al. Anaesthesia mode for caesarean section and mortality in very preterm infants: An epidemiologic study in the EPIPAGE cohort. Int J Obstet Anesth 2009; 18: 142-9.