Epidurals and fever: association or cause? CMAJ 1997;157:508 See response from: C.J. Brown The Research Update item "Epidurals and fever" (CMAJ 1997;156:1262) was certainly newsworthy for CMAJ readers; however, the analysis was inaccurate and misleading. The statement that "epidural analgesia during labour can cause [our emphasis] fever in mothers and lead to unnecessary sepsis evaluations and antibiotic treatment in newborns" is incorrect. The conclusion in the original article was that "use of epidural analgesia during labour is strongly associated [our emphasis] with the occurrence of maternal intrapartum fever."1 Changing "strongly associated" to "can cause" is a gross overstatement and only serves to distort well-presented research and mislead readers. There appears to be a link between epidural analgesia during labour and internal intrapartum fever, and this needs to be further investigated. However, the implication that epidural analgesia causes newborn sepsis is very misleading. In fact, of the 1047 women who had an epidural, 3 (0.29%) of their newborns actually had sepsis, and of the 610 women who did not have an epidural, 1 newborn (0.16%) had sepsis. There are implications for the management and diagnosis of intrapartum fever when a mother has an epidural during labour. However, your opening sentence will add to the misinformation on this very important topic. Taken out of context, your editorial comments may influence less informed individuals to promulgate that untruth and deny women the "gold standard" of safe and effective pain relief during labour. D. Gray, MD Department of Anaesthesia Brendan T. Finucane, MB, BCh Professor and Chair Department of Anaesthesia University of Alberta Hospital Edmonton, Alta. Reference Lieberman E, Lang JM, Frigoletto F Jr, Richardson DK, Ringer SA, Cohen A, et al. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 1997;99:415-9. Send a letter to the editor responding to this letter Envoyez une lettre à la rédaction au sujet de cette lettre | CMAJ September 1, 1997 (vol 157, no 5) / JAMC le 1er septembre 1997 (vol 157, no 5) |