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June 9, 1999

Epidural Analgesia and Cesarean Delivery—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(22):2084-2087. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-22-jbk0609

In Reply: While we agree that there could be potential bias using neonatal naloxone administration as an outcome, there was no evidence from the primary article that this was the case.1 Unfortunately, the criteria for the use of naloxone were not stated. We should note, however, that some women in the study received large dosages of meperidine (up to 500 mg, during the course of the labor) over a long period. These conditions are different from those reported by Gerhardt et al,2 who only studied patients given up to 3.0 mg/kg of meperidine within 3 hours of birth. Higher doses of meperidine may decrease the Apgar score and lead to the use of naloxone for respiratory depression in a small proportion of neonates.