Epidurals and fever: association or cause?
CMAJ 1997;157:508
Re: "Epidurals and fever" (CMAJ 1997;156:1262)
In response to: D. Gray, B.T. Finucane
Drs. Gray and Finucane are correct: association is not causation. The words "can cause" were not meant to editorialize or to overstate the outcome of the study by Lieberman and associates.
Furthermore, there was, in the news item, no "implication that epidural analgesia causes newborn sepsis"; on the contrary, I accurately reported Lieberman and associates' conclusion that fever during epidural analgesia can "lead to unnecessary [my emphasis] sepsis evaluations and antibiotic treatment in newborns" because the fever may have to do with the epidural analgesia rather than an infection.
What is the nature of the link between epidural analgesia and intrapartum fever? Lieberman and associates studied "1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission. . . . Intrapartum fever > 100.4°F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio = 14.5, 95% confidence interval 6.3 to 33.2)." CMAJ readers may judge for themselves.
Carolyn Joyce Brown
Editor
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