THE PREMATURE-INFANT - ANESTHESIA FOR CESAREAN DELIVERY

The influence of anesthetic technique (general [GA] versus epidural [E PI]) on neonatal outcome was assessed for singleton infants of gestati onal age 32 wk or less, delivered by cesarean section. Neonates were i dentified from a prospectively collected perinatal database from 1986 to 1991. The independent effect of anesthetic technique on low 1-min A pgar scores after controlling for other risk factors was assessed by o rdinal logistic regression. Among the 509 infants studied, 30% had Apg ar scores of 0 to 3 at 1 min and 5.9% at 5 min. Among infants delivere d with GA, 46.4% had low 1-min and 10.1% had low 5-min Apgar scores as compared to 22.0% and 3.8% for EPI. GA as compared to EPI was associa ted with higher risk of low (0-3) 1-min score after controlling for co nfounding factors (relative odds = 2.92, [1.99, 4.27 95% confidence in tervals]). Other factors significantly related to low 1-min Apgar scor es included malpresentation, maternal diabetes, primiparity, low gesta tional age, and associated neonatal outcomes (presence of respiratory distress syndrome and intraventricular hemorrhage). When there is a ch oice to be made in cesarean delivery of the premature infant, EPI is a ssociated with higher 1- and 5-min Apgar scores compared to GA.