ACOG and AAP issue report on neonatal brain injury

A “broader perspective” and a “comprehensive multidimensional assessment” are necessary to establish a causal link between intrapartum hypoxic events and neonatal encephalopathy, according to the latest report from the American College of Obstetricians and Gynecologists (ACOG) Task Force on Neonatal Encephalopathy.

The Task Force says that the latest report, copublished by the American Academy of Pediatrics and titled “Neonatal encephalopathy and neurologic outcome, second edition,” reflects that multiple causes can lead to brain injury in term infants, not just oxygen deprivation around the time of birth, as emphasized in the report’s first edition. Despite numerous advances, the researchers state, gaps still exist in what is known about cause and effect.

As a result, the Task Force says a comprehensive evaluation is necessary in all cases of neonatal encephalopathy and that, in the absence of such a multidimensional assessment, the term “neonatal encephalopathy” is more appropriate than “hypoxic-ischemic encephalopathy.”

The report says the assessment should include neonatal status and all potential contributing factors, including the mother’s medical history and any prior obstetric problems; intrapartum factors, such as fetal heart rate monitoring results and any delivery issues; and placental pathology. Neonatal signs consistent with an acute peripartum or intrapartum event include an Apgar score of less than 5 at 5 and 10 minutes after birth; fetal umbilical artery acidemia; multisystem organ failure; and the development of spastic quadriplegia or dyskinetic cerebral palsy.

Magnetic resonance imaging obtained after the first 24 hours of life can reveal distinct patterns associated with a hypoxic-ischemic event in an infant born at 35 weeks’ gestation or later, but is not always conclusive.

Other factors pointing toward a causal link include a hypoxic or ischemic event occurring immediately before or during labor and delivery; fetal heart rate monitor patterns consistent with an acute peripartum or intrapartum event; and the absence of other proximal or distal contributing factors. 

Executive Summary: Neonatal Encephalopathy and Neurologic Outcome, Second Edition. Obstet Gynecol. 2014;123(4):896–901.