Abstract 710

Background: Fentanyl is commonly used as part of the anesthetic regimen for the parturient. Although the overall safety of epidural fentanyl is well established, there is controversy as to the effect of epidural analgesia, with or without opioids, on neonatal well-being. In a previous pilot study, we evaluated the effect of epidural anesthesia with and without fentanyl on the success of breast-feeding. In that study, we found that women who had breast-fed previously, reported feeding problems less frequently than those who had not breast-fed previously. Among those who had breast-fed previously, those who had received > 150mcg fentanyl during labor reported breast-feeding difficulties more often than those who had received less or none.

Objective: To determine if epidural fentanyl administered to a woman in labor interferes with the ability of the newborn to breast-feed.

Methods: Women in labor who (1) had breast-fed previously, (2) who planned to breast-feed their newborn, and (3) who requested labor epidural anesthesia were enrolled in this ongoing prospective study. Women were randomized to one of three groups: Group 1 received no epidural fentanyl during labor (n=5), group 2 received < 150mcg epidural fentanyl (n=7), group 3 received ≥ 150 mcg epidural fentanyl during labor.

All the women received epidural bupivacaine. Cord blood was collected for batch analysis of fentanyl and norfentanyl (to be run prior to presentation). On post-partum day 1, the women were given a questionnaire by a member of the anesthesia team about their breast-feeding experience. The women were also seen by a lactation nurse (unaware of patient assignment) who assessed if they were experiencing breast-feeding problems. The neurobehavior of the infant was evaluated by a pediatrician (unaware of patient assignment) using the Neurologic and Adaptive Capacity Scoring system (NACS) on post-partum day one.

Results: The NACS were 34±1 (mean ± SD), 29±6 and 31±3 in groups 1, 2 and 3 respectively. Although there appears to be a difference in NACS among the groups, this difference is not statistically significant. Three of the twenty mothers experienced moderate to severe breast-feeding difficulties, 2 in the low-dose fentanyl group and 1 in the high-dose fentanyl group. Two of these three mothers stated only that the infant was sleepy. Only one of these three infants was found by the lactation nurse to have any breast-feeding difficulties.

Conclusion: At this early stage, intrapartum use of epidural fentanyl does not appear to impact negatively on the breast-feeding of the newborn. More patients are needed in order to reach a definitive conclusion.