title: A proposed evidence-based neonatal work-up to confirm or refute allegations of intrapartum asphyxia.
abstract: OBJECTIVE
  To propose a clinical work-up in term and near-term newborns to address the nine American College of Obstetricians and Gynecologists (the College) and American Academy of Pediatrics criteria to define an acute intrapartum event sufficient to cause cerebral palsy.
  
  
  METHODS
  We examined our experience as neonatal expert witnesses in 103 closed claims of alleged intrapartum asphyxia with poor newborn outcome over a 21-year period from 1987 to 2008. We estimated how often the clinical components of this proposed work-up were not obtained or recorded in the medical record.
  
  
  RESULTS
  Cord arterial blood gases and placental pathology were not obtained or sent in 38% and 32% of the 103 cases, respectively. Routine neonatal laboratory tests, including a complete blood count with differential, nucleated red blood cells, electrolytes, calcium, coagulation profile, and renal and liver function tests, were frequently absent. Cranial imaging in ultrasonograms, computed tomography, and magnetic resonance imaging were absent in more than 50% of the cases reviewed and were often not scheduled at optimal times.
  
  
  CONCLUSIONS
  The medical record of newborns with poor outcomes frequently has a paucity of objective, evidence-based data. This leads to speculation and unethical expert testimony. The protocol will assist in confirming or refuting allegations of intrapartum asphyxia.
  
  
  METHODS
  III.
authors.affiliation: From the Division of Neonatal-Perinatal Medicine, Loyola University Medical Center, Maywood, Illinois; and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Muraskas
authors.forename: John C
authors.initials: JC
authors.lastname: Morrison
mesh_terms: D001237:Asphyxia / Q000175:diagnosis*; D001238:Asphyxia Neonatorum / Q000175:diagnosis; D001784:Blood Gas Analysis; D002547:Cerebral Palsy / Q000209:etiology*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000032:analysis; D011247:Pregnancy
chemical_list: D010100:Oxygen