Association of maternal fever during labor with neonatal and infant morbidity and mortality

Objective: To examine the association of intrapartum fever with infant morb idity and early neonatal (0-6 days) and infant (0-364 days) death. Methods: We carried out a retrospective cohort analysis among singleton Liv e births in the United States for the period 1995-1997 using the National C enter for Health Statistics linked birth-infant death cohort data. Results: Among the 11,246,042 singleton live births during the study period , intrapartum fever (at least 38C) was recorded in 1.6%. Intrapartum fever was associated with early neonatal (adjusted odds ratio [OR], 95% confidenc e interval [CI] for preterm and term infants respectively: 1.32; 1.11, 1.56 and 1.67; 1.14, 2.46) and infant (OR, 95% CI for preterm and term, respect ively: 1.31; 1.14, 1.51 and 1.27; 1.01, 1.59) death among nulliparous mothe rs. Among preterm infants of parous mothers, intrapartum fever was associat ed with early neonatal (OR 1.29, 95% CI 1.01, 1.64) death. In the combined analyses (infants of nulliparous and parous mothers), intrapartum fever was a strong predictor of infection-related death. These associations were str onger among term (OR 3.16, 95% CI 1.56, 6.40 for early neonatal; OR 1.75, 9 5% CI 1.20, 2.57 for infant death) than preterm infants (OR 1.52, 95% CI 1. 15, 2.00 for early neonatal; OR 1.29, 95% CI 1.05, 1.57 for infant death). Intrapartum fever was also a risk factor for meconium aspiration syndrome, hyaline membrane disease, neonatal seizures, and assisted ventilation. Conclusion: Intrapartum fever is an important predictor of neonatal morbidi ty and infection-related mortality. (C) 2001 by the American College of Obs tetricians and Gynecologists.