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• W4312105410 abstract "Although epidural analgesia is widely accepted as a safe practice, concerns have been raised regarding the possibility of physiological effects on the neonate resulting from the transplacental transfer of epidurally administered opioids.1Kumar M. Paes B. Epidural opioid analgesia and neonatal respiratory depression.J Perinatol. 2003; 23: 425-427Crossref PubMed Scopus (15) Google Scholar, 2Ravelli A.C.J. Eskes M. de Groot C.J.M. Abu-Hanna A. van der Post J.A.M. Intrapartum epidural analgesia and low Apgar score among singleton infants born at term: a propensity score matched study.Acta Obstet Gynecol Scand. 2020; 99: 1155-1162Crossref PubMed Scopus (13) Google Scholar, 3Kumar M. Chandra S. Ijaz Z. Senthilselvan A. Epidural analgesia in labour and neonatal respiratory distress: a case-control study.Arch Dis Child Fetal Neonatal Ed. 2014; 99: F116-F119Crossref PubMed Scopus (10) Google Scholar This study aimed to determine the frequency of fentanyl positivity on neonatal urine drug testing as a result of transplacental transfer from neuraxial analgesia, the factors that increase the likelihood of fentanyl positivity, and whether fentanyl positivity is associated with any clinically relevant outcomes in the immediate neonatal period. This was a retrospective cohort study of all deliveries involving neuraxial analgesia with fentanyl at an academic medical center between 2018 and 2020 where universal neonatal urine toxicology testing for fentanyl is performed. Those that did not receive neuraxial fentanyl, had a positive maternal fentanyl test before epidural administration, had maternal or neonatal intravenous fentanyl administered, or delivered an infant at <24 weeks of gestation were excluded. Immediate birth outcomes and maternal characteristics were compared between infants who tested positive and those who tested negative for fentanyl. Stratified analyses were performed to address the potential confounding effects of gestational age at delivery and delivery method on immediate neonatal outcomes. This study was approved by the institutional review board at the University of Maryland. During the study period, 3594 births occurred, and 2272 maternal-infant pairs were included in the analysis. Urine toxicology testing was positive for fentanyl in 48% of infants. The mothers of the neonates who tested positive were more likely to be primiparous (66.7% vs 33.2%; P<.001), had epidurals for a longer period (11.2 vs 1.8 hours; P<.001), and received a higher dose of neuraxial fentanyl (433.4 vs 73.0 μg; P<.001). After adjusting for associated factors, infants born by vaginal delivery and unscheduled cesarean delivery had 29.5 and 84.8 times higher odds of testing positive for fentanyl, respectively, compared with those delivered by scheduled cesarean delivery. There was a dose-dependent relationship between the amount of fentanyl administered and the likelihood of positive infant toxicology testing; for example, 0.9% of infants whose birth parent received 10 μg of neuraxial fentanyl tested positive and 90.2% of those receiving >200 μg of fentanyl tested positive (Figure). To evaluate birth outcomes, analysis was restricted to term neonates (≥37 weeks of gestation; n=1767). Neonates that tested positive for fentanyl were more likely to have a 5-minute Apgar score of <7 (2.8% vs 0.9%; adjusted odds ratio, 4.8; 95% confidence interval, 1.9–11.9) but otherwise had similar birth outcomes (Table). The need for resuscitation and neonatal intensive care admission was higher in the fentanyl-negative group, but after adjusting for gestational age at birth by week and mode of delivery, these findings were no longer significant.TableComparison of immediate birth outcomes of term neonates that test positive and negative for fentanylVariableFentanyl-positive babyFentanyl-negative babyOR (95% CI)aOR (95% CI)P value5-min Apgar score of <72.8%0.9%2.9 (1.3–6.8)4.8 (1.9–11.9)aAdjusting for mode of delivery.001Need for resuscitation15.4%22.4%0.7 (0.6–0.8)1.3 (0.9–1.7)bAdjusting for mode of delivery and gestational age..12NICU admission12.2%21.3%0.6 (0.5–0.7)0.9 (0.6–1.2)bAdjusting for mode of delivery and gestational age..36Cesarean delivery16.3%59.9%0.3 (0.2–0.4)<.001Gestational age39.4±1.138.8±1.0<.001Birthweight3259±4373193±519.004Dose of epidural430±29775±105<.001Length of epidural before delivery (h)11±82±2<.001aOR, adjusted odds ratio; NICU, neonatal intensive care unit; OR, odds ratio.Mark. Transplacental transfer of neuraxial fentanyl to neonate. Am J Obstet Gynecol 2023.a Adjusting for mode of deliveryb Adjusting for mode of delivery and gestational age. Open table in a new tab aOR, adjusted odds ratio; NICU, neonatal intensive care unit; OR, odds ratio. Mark. Transplacental transfer of neuraxial fentanyl to neonate. Am J Obstet Gynecol 2023. Transplacental transfer of fentanyl and subsequent positive neonatal urine toxicology testing occurred in almost half of deliveries involving fentanyl-containing neuraxial analgesia. The likelihood of this transfer increased in a dose-dependent manner. However, there did not seem to be any immediate clinically relevant consequences associated with neonatal fentanyl positivity." @default.
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• W4312105410 date "2023-04-01" @default.
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• W4312105410 title "Rates and clinical implication of transplacental transfer of neuraxial fentanyl to neonate" @default.
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