In this study, the prevalence of respiratory depression at birth, determined on the basis of the APGAR score, was very low 1.77% and 0.059% for low APGAR and severe APGAR at 1 minute, respectively, and resolved later. It is striking to see that severe APGAR compromise occurred in 1 out of 2165 patients, suggesting that there is not association between fentanyl and neonatal respiratory depression when the APGAR score is used. Considering that its accuracy is questionable APGAR sensitivity for respiratory depression, the results presented here must be taken cautiously and it would be important to perform prospective controlled studies in order to determine respiratory depression using scales with a high positive predictive value and measurement of plasma levels of fentanyl in cord blood and in maternal blood, and to also determine a causal gradient of depression in neonates born through C-section under this anesthetic technique. I am grateful to the Mother and Child Clinic, the Anesthesiology Department and HMO Saludcoop Corporation for their support for this work; to El Bosque University and its Clinical Epidemiology Group for their teachings and support; an to my family my parents, Ana María, Santiago and Clarisa.
Para este estudio, la prevalencia de depresión respiratoria al nacer valorada con APGAR es muy baja el 1,77 y el 0,059% para APGAR bajo y APGAR severo al primer minuto respectivamente, con resolución posterior; llama la atención que el compromiso severo del APGAR se presentó en 1 de 2.165 pacientes, lo que indica de manera relevante la ausencia de asociación entre fentanilo y depresión respiratoria neonatal al ser valorado con APGAR; dado a que es cuestionable su precisión sensibilidad del APGAR para depresión respiratoria, los resultados aquí presentados se deben tomar con precaución y correspondería realizar protocolos prospectivos controlados para determinar depresión respiratoria a través de escalas de alto valor predictivo positivo y medición de concentraciones séricas de fentanilo en sangre de cordón y arteria materna para determinar un gradiente causal de depresión en los neonatos extraídos por cesárea con esta técnica anestésica.