The premature infant: anesthesia for cesarean delivery.

The influence of anesthetic technique (general [GA] versus epidural [EPI]) on neonatal outcome was assessed for singleton infants of gestational age 32 wk or less, delivered by cesarean section. Neonates were identified from a prospectively collected perinatal database from 1986 to 1991. The independent effect of anesthetic technique on low 1-min Apgar scores after controlling for other risk factors was assessed by ordinal logistic regression. Among the 509 infants studied, 30% had Apgar scores of 0 to 3 at 1 min and 5.9% at 5 min. Among infants delivered with GA, 46.4% had low 1-min and 10.1% had low 5-min Apgar scores as compared to 22.0% and 3.8% for EPI. GA as compared to EPI was associated with higher risk of low (0-3) 1-min score after controlling for confounding factors (relative odds = 2.92, [1.99, 4.27 95% confidence intervals]). Other factors significantly related to low 1-min Apgar scores included malpresentation, maternal diabetes, primiparity, low gestational age, and associated neonatal outcomes (presence of respiratory distress syndrome and intraventricular hemorrhage). When there is a choice to be made in cesarean delivery of the premature infant, EPI is associated with higher 1- and 5-min Apgar scores compared to GA.