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Maternal fever in labour and neonatal seizures

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Maternal fever in labour seems to be associated with an increased risk of unexplained seizures in the neonate. In Boston, USA it was noticed that infants born to mothers with intrapartum fever were more likely to be hypotonic at birth and to need resuscitation; they also seemed more prone to unexplained seizures. This observation led to a retrospective case control study (Ellice Lieberman and colleagues. Pediatrics2000;106:983–8).  Records from 1989–96 identified 38 cases (with unexplained neonatal seizures) and 152 controls matched for parity and date of birth. A maternal fever (38° C or greater) during labour occurred in 32% of the seizure group and 9% of controls. After controlling for confounding factors, maternal intrapartum fever increased the risk of unexplained neonatal seizures 3.4 fold. There was no evidence that the maternal fevers were due to infection. Some may have been related to epidural analgesia.  The possible mechanism behind this relationship is uncertain. It is suggested that maternal cytokines or the augmentation of the effects of hypoxia by fever might affect the fetal and neonatal brain.