Antenatal antecedents of moderate or severe neonatal encephalopathy in term infants--a regional review.
BACKGROUND
Regional audits of term infants with neonatal encephalopathy (NE) provide an opportunity to examine issues related to causation and quality of care.


OBJECTIVE
To document antenatal and intrapartum antecedents in a contemporary cohort of term infants with moderate or severe neonatal encephalopathy.


METHODS
Term infants admitted with moderate-severe neonatal encephalopathy over 4 years were identified. The clinical records were reviewed for information about the pregnancy and birth including interpretation of monitoring and subsequent management of the labour and delivery.


RESULTS
Fifty-two maternal records were reviewed. No mothers were diabetic or had gestations > 42 weeks, but 17% of the babies were small for gestational age (SGA). The cohort had evidence of antenatal hypoxia in 15%, a sentinel event in 25% and suboptimal fetal monitoring practice in at least 42% of cases.


CONCLUSIONS
Peripartum events were the major contributors to neurological damage in infants with neonatal encephalopathy. Suboptimal fetal monitoring practice and sentinel events remain the most common contributors. Ongoing education and training to address these issues should be available to all involved with intrapartum care in New Zealand.
West
Claire R
CR
Liggins Institute, University of Auckland, Auckland, New Zealand.
Curr
Liz
L
Battin
Malcolm R
MR
Harding
Jane E
JE
McCowan
Lesley M
LM
Belgrave
Sue
S
Knight
David B
DB
Westgate
Jenny A
JA
D000328:Adult; D001724:Birth Weight; D001927:Brain Diseases / Q000209:etiology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005323:Fetal Monitoring; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D008485:Medical Audit; D009520:New Zealand; D007744:Obstetric Labor Complications; D011247:Pregnancy; D012189:Retrospective Studies