Neonatal shivering and hypothermia after intrapartum amnioinfusion

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Since Miyazaki and Taylor first proposed intrauterine instillation of normal saline to relieve variable decelerations, it has become an accepted procedure not only to abort variable decelerations but to dilute thick meconium and replace amniotic fluid in cases of oligohydramnios. Complications of amnioinfusion although rare include uterine overdistension and amniotic fluid embolism. We report three cases of shivering and hypothermia after amnioinfusion in otherwise healthy neonates. A 27-year-old term primigravida underwent amnioinfusion because of persistent variable decelerations. Amnioinfusion was initiated with a bolus of 500 mL of normal saline at room temperature and continued at a rate of 500 mL/h for a total of 3 h. The patient had an uneventful vaginal delivery. Upon delivery, the baby was noted to be shivering and the body temperature was 35·2oC. Apgar scores were 5 at 1 min and 7 at 5 min. The baby was warmed and able to be extubated. There were no other complications and he was discharged with his mother on day 3. Amnioinfusion was started on a 32-year-old multigravida at 35 weeks and 2 days of gestation for persistent variable decelerations. The amnioinfusion protocol was similar to above. A preterm baby was born pale and shivering with Apgar scores of 5 at 1 min and 7 at 5 min. His weight was 3010 g. Umbilical artery pH was 7·26. The baby’s body temperature was 35oC. The baby was warmed in an incubator set 1·5oC above normal, and oxygen was administered. Subsequently, he did well and was discharged from the hospital on day 6 of life. A 34-year-old was admitted to hospital at 35 weeks of pregnancy with preterm premature rupture of membranes leaking thick meconium. An amnioinfusion with the same protocol was continued for 6 h. The baby was born with Apgar scores of 7 at 1 min and 8 at 5 min. The baby was shivering, and his temperature was 35·3oC. After warming, the baby stopped shivering and his skin colour improved. He was discharged from hospital on day 3 of life. In a questionnaire study of amnioinfusion prevalence, protocols, and complications, 26% of responders reported at least one complication of the procedure including uterine Losartan-associated atypical cutaneous lymphoid hyperplasia