Anaesthesia mode for caesarean section and mortality in very preterm infants: An epidemiologic study in the EPIPAGE cohort

Laudenbach, V.; Mercier, F.J.; Rozé, J.-C.; Larroque, B.; Ancel, P.-Y.; Kaminski, M.; Bréart, G.; Diemunsch, P.; Subtil, D.; Lejus, C.; Fresson, J.; Arnaud, C.; Rachet, B.; Burguet, A.; Cambonie, G.; Epipage Study Group,

doi:10.1016/j.ijoa.2008.11.005

« Previous Next »International Journal of Obstetric Anesthesia
Volume 18, Issue 2 , Pages 142-149, April 2009

Anaesthesia mode for caesarean section and mortality in very preterm infants: An epidemiologic study in the EPIPAGE cohort

V. Laudenbach
- Department of Neonatology and Pediatric Intensive Care & EA 4309 NeoVasc Research Group, Rouen Institute for Biomedical Research, University of Rouen, Rouen, France
- Correspondence to: Vincent Laudenbach, M.D., Ph.D., Professor of Anesthesiology, Service de Pédiatrie Néonatale et Réanimation, CHU Charles Nicolle, 1 rue de Germont, 76031 Rouen Cedex, France.
F.J. Mercier
- Department of Anesthesiology, Assistance Publique – Hôpitaux de Paris, Antoine Béclère University Hospital, Clamart & University of Paris XI, France
J.-C. Rozé
- Department of Perinatalogy, University Hospital, Nantes, France
B. Larroque
- INSERM U149, Epidemiological Research Unit on Perinatal and Women’s Health, Villejuif, France
P.-Y. Ancel
- INSERM U149, Epidemiological Research Unit on Perinatal and Women’s Health, Villejuif, France
M. Kaminski
- INSERM U149, Epidemiological Research Unit on Perinatal and Women’s Health, Villejuif, France
G. Bréart
- INSERM U149, Epidemiological Research Unit on Perinatal and Women’s Health, Villejuif, France
P. Diemunsch
- Department of Anesthesiology, University Hospital, Strasbourg, France
D. Subtil
- Department of Obstetrics and Gynecology, University Hospital, Lille, France
C. Lejus
- Department of Anesthesiology, University Hospital, Nantes, France
J. Fresson
- Department of Neonatology, University Hospital, Nancy, France
C. Arnaud
- INSERM U 558, Toulouse, France
B. Rachet
- Department of Anesthesiology, University Hospital, Rouen, France
A. Burguet
- Department of Neonatology, University Hospital, Dijon, France
G. Cambonie
- Department of Neonatology, University Hospital, Montpellier, France
Epipage Study Group
- The EPIPAGE Study Group includes the following: B Larroque (national coordinator), PY Ancel, B Blondel, G Bréart, M Dehan, M Garel, M Kaminski, F Maillard, C du Mazaubrun, P Missy, K Supernant (INSERM U149, Paris, France);M Durand, J Matis, J Messer, A Treisser (Hôpital de Hautepierre, Strasbourg, France);A Burguet, L Abraham-Lerat, A Menget, P Roth, J-P Schaal, G Thiriez (University Hospital St Jacques, Besançon, France);C Lévêque, S Marret, L Marpeau (University Hospital Charles Nicolle, Rouen, France);P Boulot, J-C Picaud (University Hospital Arnaud de Villeneuve, Montpellier, France);A-M Donadio, B Ledésert (Regional Health Observatory of Montpellier, France);André, J. Fresson, JL Boutroy, JM Hascoët (University Regional Maternity, Nancy, France);C Arnaud, S Bourdet-Loubère, H Grandjean (INSERM U558, Toulouse, France);M Rolland (Children Hospital, Toulouse, France);C Leignel, P Lequien, V Pierrat, F Puech, D Subtil, P Truffert (University Hospital Jeanne de Flandre, Lille, France);G Boog, E Le Mauff, V Rouger-Bureau, J-C Rozé (University Mothers & Children Hospital, Nantes);P-Y Ancel, G Bréart, M Kaminski, C du Mazaubrun (INSERM U149, Paris, France), M Dehan, V Zupan (University Hospital Antoine Béclère, Clamart, France);M Vodovar, M Voyer (Institut de Puériculture, Paris, France).The EPIPAGE cohort study received financial support from the INSERM (Institut National de la Santé et de la Recherche Médicale), Merck-Sharp, Dohme-Chivret, the FRM (Fondation pour la Recherche Médicale), and the Direction Générale de la Santé (French Ministry of Health).

Accepted 20 November 2008. published online 05 February 2009.

Abstract

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.

Keywords: Caesarean section, Premature infants, Mortality, Anaesthesia, Obstetrical