By Jennifer M. Bonck or Tammy J. Gay

“As reported in this monograph, we now know that less than 10% of cases of neurologic impairment in newborns are the result of asphyxial events occurring in labor and, of the other 90% very few are preventable. This report provides a better understanding of the causes of these two conditions and should serve as a valuable guide for future research to discover new preventions or treatment. At this time, this knowledge should benefit the entire medical community, the courts, and for all those who care for infants and children with these disabilities. It is not unreasonable to assume that this knowledge can potentially reduce the health care costs and improve health care access for consumers by reducing malpractice insurance costs.”

-- Frank Miller, M.D., professor, Dept. of Obstetrics and Gynecology, UK College of Medicine

Feb. 21, 2003 (Lexington, Ky.) -- The findings of a task force initiated by a University of Kentucky physician may improve the understanding and treatment of fetal and newborn brain injury.

While president of the American College of Obstetricians and Gynecologists (ACOG), Frank Miller, M.D., professor, Department of Obstetrics and Gynecology, UK College of Medicine, assembled a task force, the ACOG Task Force on Neonatal Encepalopathy and Cerebral Palsy, to examine the causes of newborn brain injury.

"For years, adverse neurological outcomes of pregnancy, including cerebral palsy and neonatal encephalopathy, have been assumed to be almost exclusively the effect of events occurring during childbirth, and this has resulted in many Obstetricians being faulted,” Miller said. “There were many times that despite doing everything we knew to do, we still had negative outcomes. We needed to address what was going wrong.”

This initiative, begun in 2000, has resulted in a report issued by ACOG and the American Academy of Pediatrics (AAP), which concludes that the majority of newborn
brain injury cases do not occur during labor and delivery. Rather, most instances of neonatal encephalopathy and cerebral palsy are attributable to events occurring before labor begins.

“As reported in this monograph, we now know that less than 10% of cases of neurologic impairment in newborns are the result of asphyxial events occurring in labor and, of the other 90% very few are preventable.” Miller said. “This report provides a better understanding of the causes of these two conditions and should serve as a valuable guide for future research to discover new preventions or treatment. At this time, this knowledge should benefit the entire medical community, the courts, and for all those who care for infants and children with these disabilities. It is not unreasonable to assume that this knowledge can potentially reduce the health care costs and improve health care access for consumers by reducing malpractice insurance costs.”

Neonatal encephalopathy is a condition characterized by abnormal consciousness, poor muscle tone and reflexes, difficulty initiating or maintaining breathing, or seizures, and may or may not result in permanent neurological impairment. In contrast, cerebral palsy is a chronic developmental disability of the central nervous system recognized by uncontrollable movement and posture.

The report, Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology, gives evidence that the vast majority of neonatal encephalopathy and cerebral palsy originate from developmental or metabolic abnormalities, autoimmune and coagulation defects, infection, trauma, or combinations of these factors. The report has received the endorsement of six organizations including the National Institute of Child Health and Human Development of the National Institutes of Health and the Centers for Disease Control and Prevention.

Newborn encephalopathy and cerebral palsy are associated with significant mortality rates and long-term morbidity and have been central in the assignment of blame in obstetric litigation. However, the report confirms that hypoxia (or insufficient supply of oxygen) during labor or delivery is not a significant cause in most of the cases of neonatal encephalopathy or cerebral palsy. One out of four infants with neonatal encephalopathy had any evidence of hypoxia during labor. The report also concluded that an underlying event before labor was the primary factor for the adverse outcome in 70 percent of neonatal encephalopathy cases and contributory in another 25 percent.

The report lists the criteria to define and evaluate the probability that encephalopathy and cerebral palsy were a result of fetal asphyxia occurring -during labor.

“By helping to understand the causes of neonatal encephalopathy and cerebral palsy, our efforts may lead to more focused research and clinical interventions that will
reduce the rates of these serious pathologies,” Miller said.

The ACOG task force was formed in 2000 and the resulting report was co-authored by the AAP. The task force was comprised of a panel of medical experts
representing the specialties of maternal-fetal medicine, pediatrics, neuroepidemiology, radiology, and pathology. This report complements and updates a 1999 consensus statement by an International Cerebral Palsy Task Force that was published in the British Medical Journal.

The report has been endorsed by the following professional organizations: the March of Dimes Birth Defects Foundation, the Society for Maternal and Fetal Medicine, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada. The Child Neurology Society recommends this report as a valuable reference tool.