FRIDAY, Jan. 31, 2003 (HealthDayNews) -- It's been commonly assumed that many cases of brain damage and cerebral palsy in infants were caused by a lack of oxygen during labor and delivery, but a new report challenges that assumption.
The report says less than one quarter of all infants with a brain injury known as neonatal encephalopathy or cerebral palsy show any signs of oxygen deprivation during labor. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics jointly released the research on Jan. 31.
"These are such devastating events," says Dr. Gary Hankins, chairman of the ACOG task force that developed the report. "But, realistically, the bulk of these events are not the mother's fault, or the hospital's, nurse's or doctor's fault."
Neonatal encephalopathy literally means that a baby's brain structure or function has been damaged. Signs of neonatal encephalopathy include abnormal consciousness, poor muscle tone and reflexes, difficulty breathing, and seizures. The damage can be temporary. According to Hankins, scientists suspect the rate of neonatal encephalopathy is around three for every 1,000 births.
Cerebral palsy affects about one to two babies out of every 1,000 births. It is a permanent developmental disability that causes uncontrollable movements and posture.
According to the report, problems in labor and delivery are responsible for only about 6 percent to 10 percent of cases of infant brain injury and cerebral palsy. In about 70 percent of the neonatal encephalopathy cases, there is another underlying risk factor directly responsible or at least partially responsible in about 25 percent of the cases, concludes the report.
Some of the underlying causes are infection, trauma, metabolic problems, blood-clotting disorders and autoimmune diseases. Hankins says anything that might cause severe growth restriction in an infant can increase the risk for neonatal encephalopathy. Preeclampsia, thyroid disease and diabetes are all potential culprits.
Hankins says the assumption that labor and delivery caused these conditions has been a huge litigation problem for obstetricians, and he hopes this report will help to educate obstetricians, the public, and judges and juries. Of the 6 percent to 10 percent of cases attributable to labor and delivery problems, Hankins concedes that some of those cases are due to inadequate medical care, but says many also stem from highly challenging delivery problems, such as uterine rupture.
The report, aside from being jointly authored by the AAP, was also endorsed by numerous independent sources, including the National Institute of Child Health and Human Development, the U.S. Centers for Disease Control and Prevention and the March of Dimes Birth Defects Foundation.
"The good news is that it's not the obstetrician's fault," says Dr. Ralph Dauterive, chairman of the obstetrics and gynecology department at Ochsner Clinic Foundation in New Orleans. "The bad news is that there's probably not a lot we can do about it in labor."
He says the report really just confirms what obstetricians have known all along. And to expectant mothers, he says, "It's really the same message you've been hearing all along." Take folic acid before you get pregnant and during your pregnancy. Don't drink alcohol. Don't smoke. If you have a chronic condition such as diabetes or a thyroid disorder, make sure it's well-controlled. And get proper prenatal care.
Hankins agrees with these suggestions to optimize maternal health, but says there are really no proven strategies to reduce your risk of delivering a baby with neonatal encephalopathy or cerebral palsy.
"People need to understand that there are inherent risk factors to pregnancy that are largely determined by genetics and environment," Hankins says.
More information
To learn more about cerebral palsy, visit the National Institute of Neurological Disorders and Stroke. The March of Dimes offers these tips on getting ready for a healthy pregnancy before conception.
