Neonatal Encephalopathy and Neurologic Outcome, Second Edition

Abstract

In the first edition of this report, the Task Force on Neonatal Encephalopathy and Cerebral Palsy outlined criteria deemed essential to establish a causal link between intrapartum hypoxic events and cerebral palsy. It is now known that there are multiple potential causal pathways that lead to cerebral palsy in term infants (see Fig 1), and the signs and symptoms of neonatal en-cephalopathy may range from mild to severe, depending on the nature and timing of the brain injury. Thus, for the current edition, the Task Force on Neonatal Encephalopathy determined that a broader perspective may be more fruitful. This conclusion reflects the sober recognition that knowl-edge gaps still preclude a definitive test or set of markers that accurately identifies, with high sensitivity and specificity, an infant in whom neonatal encephalopathy is attributable to an acute intrapartum event. The information necessary for assessment of likelihood can be derived from a comprehensive evaluation of all potential con-tributing factors in cases of neonatal encephalopathy. This is the broader perspective championed in the current report. If a compre-hensive etiologic evaluation is not possible, the term hypoxic–ischemic encephalopathy should best be replaced by neonatal encephalopathy because neither hypoxia nor ischemia can be assumed to have been the unique initiating causal mechanism. The title of this report has been changed from Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology to Neonatal Enceph-alopathy and Neurologic Outcome to indicate that an array of develop-mental outcomes may arise after neonatal encephalopathy in addition to cerebral palsy. To determine the likelihood that an acute hypoxic–ischemia event that occurred within close temporal proximity to labor and de-livery contributed to neonatal encephalopathy, it is recommended that a comprehensive multidimensional assessment be per-formed of neonatal status and all potential contributing factors, including maternal medical history, obstetric antecedents, intrapartum factors (including fetal heart rate monitoring results and issues relating to the delivery itself), and placental pathology. A description of the items to be included in the assessment fol-lows.