A new report sheds light on possible determinants of brain injury in newborns, explaining nervous system damage is complex and often occurs well before labor and delivery, during (or even before) the pregnancy. Traditionally, brain injuries discovered among newborns had been thought to be most frequently associated with deficiencies in oxygen levels during labor and delivery. Parents in turn placed the blame on doctors, who with limited alternative diagnosis and treatment were plagued with malpractice suits.
However, a recently updated report, Neonatal Encephalopathy and Neurologic Outcome, published by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, claims most neurological abnormalities are not due to complications such as oxygen deprivation or asphyxia at birth. Jane Brody of the NYTimes writes, ¦fewer than 10 percent of children with cerebral palsy, the most severe such brain injury, showed signs of asphyxia at birth.
Instead, the revised document asserts different causes of neonatal encephalopathy, the formal characterization of disturbed brain function with the first days of newborns. The varied causes of neurologic disorders include: genetic factors and maternal health problems like hypothyroidism, placental abnormalities, major bleeding during pregnancy, infection of the fetal membranes and a stroke in the baby around the time of birth.
The report goes on to summarize methods to accurately define insufficient oxygen and blood supply during labor and delivery as the source of brain dysfunction. These tests are low Apgar score at 5 and 10 minutes after birth; high acid level (called acidemia) in the umbilical artery; major organ failure; and an M.R.I. scan showing a particular pattern of cerebral injury.
A combination of these factors is used to precisely diagnose brain injury, including the timing of the neural insult. Presently, there are limited treatments available to help reverse the damage left by neural complications. However, the report emphasizes prevention of brain injury in newborns rests upon changing the culture of health care delivery from one that names and blames to one that is dedicated to reducing medical errors through a constructive, nonthreatening and professional process.
ACSH s Dr. Gil Ross commented, Ah, if only it were that simple! But changing the ingrained culture of both doctors and lawyers would be required to attain that nirvana of truthful and productive communication and education. Doctors are defensive, not only by nature but as a mechanism to protect against predatory lawsuits alleging their responsibility for injuries they could never have prevented; ob-gyns are among the most targeted in this manner. If simple award criteria for injuries possibly sustained during labor and delivery could be assessed without assigning blame, with compensation given out of a public fund, maybe then doctors and patients could discuss the nature of the problems realistically, leading to productive changes in the system.
