For Release: January 31, 2003, 12:01 am (ET)
WASHINGTON, DC/CHICAGO, IL - A report issued today by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) 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.
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 neurologic 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 seven 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, with less than one-quarter of infants with neonatal encephalopathy having 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% of neonatal encephalopathy cases and contributory in another 25%.
"A helpful aspect of this report is that it lists the criteria to define and evaluate the probability that encephalopathy and cerebral palsy were a result of actions during labor," explains Gary D.V. Hankins, M.D., chair of the ACOG task force that developed the report. "By helping to understand the causes of neonatal encephalopathy and cerebral palsy, our efforts may lead to clinical interventions that will reduce the rates of these serious pathologies," he adds.
"For years, adverse neurologic outcomes of pregnancy, including cerebral palsy and neonatal encephalopathy, have been assumed to be the effect of events occurring during childbirth. In the face of a bad outcome, many faulted ob-gyns. We now know that less than 10% of cases of neurologic impairment in newborns are the result of events occurring in labor and, of these, the majority were not preventable. This report provides a better understanding of the causes of these two conditions and should serve as a valuable resource for the entire medical community, the courts, and for all those who care for infants and children with these disabilities," comments ACOG President Charles B. Hammond, M.D.
The report was developed by an ACOG task force formed in 1999 and was co-authored by the AAP. The task force was comprised of a multi-specialty 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 AAP welcomes this important report. It confirms that most brain injuries are not due to the events occurring during labor, delivery, resuscitation, or treatment immediately following birth. We remain concerned about infants with neonatal brain injury, and will continue our commitment to our Neonatal Resuscitation Program that assures pediatricians and other medical professionals receive the most up-to-date instruction in resuscitation skills," says AAP President E. Stephen Edwards, M.D.
The report was also endorsed by the following professional organizations: the March of Dimes Birth Defects Foundation, the Society for Maternal and Fetal Medicine, the Child Neurology Society, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada.