Is neonatal neurological damage in the delivery room avoidable? Experience of 33 levels I and II maternity units of a French perinatal network.
OBJECTIVE
To determine the frequency of avoidable neonatal neurological damage.


METHODS
We carried out a retrospective study from January 1st to December 31st 2003, including all children transferred from a level I or II maternity unit for suspected neurological damage (SND). Only cases confirmed by a persistent abnormality on clinical examination, EEG, transfontanelle ultrasound scan, CT scan or cerebral MRI were retained. Each case was studied in detail by an expert committee and classified as "avoidable", "unavoidable" or "of indeterminate avoidability." The management of "avoidable" cases was analysed to identify potentially avoidable factors (PAFs): not taking into account a major risk factor (PAF1), diagnostic errors (PAF2), suboptimal decision to delivery interval (PAF3) and mechanical complications (PAF4).


RESULTS
In total, 77 children were transferred for SND; two cases were excluded (inaccessible medical files). Forty of the 75 cases of SND included were confirmed: 29 were "avoidable", 8 were "unavoidable" and 3 were "of indeterminate avoidability". Analysis of the 29 avoidable cases identified 39 PAFs: 18 PAF1, 5 PAF2, 10 PAF3 and 6 PAF4. Five had no classifiable PAF (0 death), 11 children had one type of PAF (one death), 11 children had two types of PAF (3 deaths), 2 had three types of PAF (2 deaths).


CONCLUSIONS
Three quarters of the confirmed cases of neurological damage occurring in levels I and II maternity units of the Aurore network in 2003 were avoidable. Five out of six cases resulting in early death involved several potentially avoidable factors.
Dupuis
O
O
Cellule des Transferts Périnataux de la Région Rhône-Alpes, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69008 Lyon, France. olivier.dupuis@chu-lyon.fr
Dupont
C
C
Gaucherand
P
P
Rudigoz
R-C
RC
Fernandez
M P
MP
Peigne
E
E
Labaune
J M
JM
D001720:Birth Injuries / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005602:France / Q000453:epidemiology; D006771:Hospitals, Maternity; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data*; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D036801:Parturition; D018743:Perinatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors