The relationship between intrapartum maternal fever and neonatal acidosis as risk factors for neonatal encephalopathy

OBJECTIVES: This study was undertaken to investigate the relationship among maternal intrapartum fever, neonatal acidosis, and the risk of neonatal encephalopathy. STUDY DESIGN: Cohort study of pregnancies at term. Logistic regression was used to estimate the effect of maternal fever and acidosis on the risk of neonatal encephalopathy. The potential interaction between maternal fever and acidosis was included in the models. RESULTS: Of 8299 women, 25 neonates (0.3%) had encephalopathy develop. These were more often born acidotic (adjusted odds ratio 11.5; 95% CI, 5.0-26.5) or after a maternal intrapartum fever (adjusted odds ratio 8.1; 95% CI, 3.5-18.6). Where both risk factors coexisted, the risk was 12.5% (adjusted odds ratio 93.9; 95% CI, 28.7-307.2). Although this effect is multiplicative, there was no evidence of statistical interaction (P = .93); the effect of maternal fever on the risk of encephalopathy was similar in infants with (adjusted odds ratio 8.7; 95% CI, 2.4-31.7) and without acidosis (adjusted odds ratio 7.4; 95% CI, 2.4-21.9). CONCLUSION: The combination of a maternal fever with cord acidosis greatly increases the risk of neonatal encephalopathy, but there is evidence against interaction between them, suggesting that they represent 2 separate causal pathways.