Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
To the Editor: In Dr Halpern and colleagues'
meta-analysis of the risk for cesarean delivery associated with the use
of epidural vs parenteral opioid analgesia in labor,1 a
secondary outcome measure was the use of naloxone in the neonate. Of
the 10 studies analyzed, 2 included data on naloxone use. Combining the
data in these 2 studies, Halpern et al found a statistically
significant increase in neonatal naloxone use in the infants born to
mothers who received parenteral opioid vs those born to mothers who
received epidural analgesia. They interpreted this use of naloxone as
indicating a less favorable neonatal outcome, although, in these 2
studies, there was no significant difference in the Apgar scores or
umbilical artery pH between the analgesia groups.
Herschel M, Mittendorf R. Epidural Analgesia and Cesarean Delivery. JAMA. 1999;281(22):2084-2087. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-22-jbk0609