Document Detail


Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort.
MedLine Citation:
PMID:  19195873     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Little is known about the influence of anaesthesia for caesarean section on outcome in very preterm infants. METHODS: A prospective, population-based, cohort study (the EPIPAGE cohort) included all births before 33 weeks in nine French regions in 1997. Of 2360 infants live-born between 27 and 32 weeks, 1338 were delivered by caesarean section with general anaesthesia (n=711, 53.1%), spinal anaesthesia (n=419, 31.3%), or epidural anaesthesia (n=208, 15.6%). Neonatal mortality was compared among these three groups using bi- (according to gestational age and to anaesthetic technique) and multivariate analyses. RESULTS: Neonatal mortality was 10.1% with general anaesthesia, 12.2% with spinal anaesthesia and 7.7% with epidural anaesthesia. After adjustment for gestational age and characteristics of pregnancy, delivery and neonate, spinal anaesthesia was associated with a higher risk of neonatal death than general anaesthesia (adjusted odds ratio, 1.7; 95% confidence interval 1.1 to 2.6). CONCLUSION: In this population-based study, spinal anaesthesia was associated with an increased risk of neonatal mortality in very preterm infants compared to general anaesthesia (and epidural anaesthesia), independently from gestational age and characteristics of the pregnancies, deliveries and neonates. Although this multivariate analysis does not prove a causal relationship, the results suggest it could exist, particularly if maternal haemodynamics are poorly controlled. With recent significant change in the conduct of spinal anaesthesia, further studies are needed to investigate potential harmful effects of anaesthesia on very preterm infants delivered by caesarean section.
Authors:
V Laudenbach; F J Mercier; J-C Rozé; B Larroque; P-Y Ancel; M Kaminski; G Bréart; P Diemunsch; D Subtil; C Lejus; J Fresson; C Arnaud; B Rachet; A Burguet; G Cambonie;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-02-04
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  18     ISSN:  1532-3374     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-23     Completed Date:  2009-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  142-9     Citation Subset:  IM    
Affiliation:
Department of Neonatology and Pediatric Intensive Care, Rouen Institute for Biomedical Research, University of Rouen, Rouen, France. vincent.laudenbach@chu-rouen.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Obstetrical*
Apgar Score
Cesarean Section*
Cohort Studies
Female
Fetal Growth Retardation / pathology
France / epidemiology
Gestational Age
Humans
Infant Mortality*
Infant, Newborn
Infant, Premature*
Obstetric Labor, Premature
Population
Pregnancy
Prospective Studies
Risk Assessment
Young Adult
Investigator
Investigator/Affiliation:
B Larroque / ; P Y Ancel / ; B Blondel / ; G Bréart / ; M Dehan / ; M Garel / ; M Kaminski / ; F Maillard / ; C du Mazaubrun / ; P Missy / ; K Supernant / ; M Durand / ; J Matis / ; J Messer / ; A Treisser / ; A Burguet / ; L Abraham-Lerat / ; A Menget / ; P Roth / ; J-P Schaal / ; G Thiriez / ; C Lévêque / ; S Marret / ; L Marpeau / ; P Boulot / ; J-C Picaud / ; A-M Donadio / ; B Ledésert / ; André / ; J Fresson / ; J L Boutroy / ; J M Hascoët / ; C Arnaud / ; S Bourdet-Loubère / ; H Grandjean / ; M Rolland / ; C Leignel / ; P Lequien / ; V Pierrat / ; F Puech / ; D Subtil / ; P Truffert / ; G Boog / ; E Le Mauff / ; V Rouger-Bureau / ; J-C Rozé / ; P-Y Ancel / ; G Bréart / ; M Kaminski / ; C du Mazaubrun / ; M Dehan / ; V Zupan / ; M Vodovar / ; M Voyer /

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