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Am J Perinatol 2019; 36(08): 828-834
DOI: 10.1055/s-0038-1675329
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal Epidural Steroids to Prevent Neonatal Exposure to Hyperthermia and Inflammation

Christopher Goodier
1   Department of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina
,
Roger Newman
1   Department of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina
,
Latha Hebbar
2   Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina
,
Julie Ross
3   Department of Neonatology, Medical University of South Carolina, Charleston, South Carolina
,
Cynthia Schandl
4   Department of Pathology, Medical University of South Carolina, Charleston, South Carolina
,
Laura Goetzl
5   Department of Maternal-Fetal Medicine, University of Texas Health Science Center, Houston, Texas
› Author Affiliations Funding This study was funded by the Department of OBGYN Center for Women's Health Research and Research Development Fund. In addition, the project described was supported by the NIH National Center for Advancing Translational Sciences (NCATS) through Grant Number UL1 TR001450.
Further Information

Publication History

21 September 2017

15 September 2018

Publication Date:
02 November 2018 (online)

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Abstract

Background Epidural analgesia is associated with a fourfold increased rate of intrapartum fever. The likely pathophysiology is a noninfectious maternal inflammatory activation. Safe interventions to reduce maternal and neonatal exposures to intrapartum fever and inflammation are needed.

Objective The purpose of this study was to determine if prophylactic epidural steroids decrease fetal exposure to hyperthermia and inflammatory cytokines following epidural analgesia.

Study Design This is a randomized, double-blinded, placebo controlled trial. Term nulliparous women requesting epidural analgesia received 80 mg methylprednisolone or preservative-free normal saline via the epidural catheter at placement. The primary outcome was maternal temperature >100.4°F. Secondary outcomes included fetal exposure to inflammation as assessed by cord blood interleukin-6 (IL-6) levels and rates of funisitis. Power analysis estimated a sample size requirement of 276, but new Food and Drug Administration (FDA) recommendations advising a black box warning on epidural steroids resulted in early study termination.

Results A total of 116 subjects were enrolled: 58 treatments and 58 placebos. There was no difference in the rate of maternal intrapartum fever or cord blood IL-6 levels between treatment arms. No complications listed in the FDA warning occurred.

Conclusion Prophylactic epidural methylprednisolone was not effective in reducing intrapartum fever or neonatal inflammation following epidural analgesia. Alternate mechanisms and preventative strategies should be considered.

Keywords

epidural analgesia - maternal fever - chorioamnionitis - inflammation - steroids - labor - funisitis

Condensation

Prophylactic epidural methylprednisolone was not effective in reducing intrapartum fever or neonatal inflammation following epidural analgesia.


Note

These findings were presented as poster at the 35th SMFM Annual Meeting—The Pregnancy Meeting. February 2–7, 2015, San Diego, CA. This study was registered at www.ClinicalTrials.gov (NCT02212210).


 

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