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To the Editor: In Dr Halpern and colleagues' meta-analysis of the risk for cesarean delivery associated with the use of epidural vs parenteral opioid analgesia in labor,¹ a secondary outcome measure was the use of naloxone in the neonate. Of the 10 studies analyzed, 2 included data on naloxone use. Combining the data in these 2 studies, Halpern et al found a statistically significant increase in neonatal naloxone use in the infants born to mothers who received parenteral opioid vs those born to mothers who received epidural analgesia. They interpreted this use of naloxone as indicating a less favorable neonatal outcome, although, in these 2 studies, there was no significant difference in the Apgar scores or umbilical artery pH between the analgesia groups.

In our opinion, the criterion of naloxone use ought not to be a factor in assessing neonatal outcome because of the potential for bias in its use. . . . [Full Text of this Article]

Stephen Halpern, MD, MSc, FRCPC; Arne Ohlsson, MD, MSc, FRCPC
University of Toronto
Toronto, Ontario