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Updated monograph outlines advances in diagnosis, pathophysiology, treatment of

neonatal encephalopathy
Jay P. Goldsmith and Lu-Ann Papile
AAP News 2014;35;18
DOI: 10.1542/aapnews.2014355-18

The online version of this article, along with updated information and services, is located on the
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http://aapnews.aappublications.org/content/35/5/18

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documentation of obstetric factors such as maternal history before and during pregnancy. analysis of labor with an emphasis on fetal heart monitoring interpretation. and documentation of historic events and outcomes. developmental delay) may be the consequence of processes that cause neonatal encephalopathy.org/ at Pakistan:AAP Sponsored on May 3.aapnews. neuroimaging findings. M. In March. prolonged fetal bradycardia.org Pediatricians and the Law Updated monograph outlines advances in diagnosis. There also is an emphasis on early identification of an encephalopathic newborn so that prompt referral can be made to a center that offers therapeutic hypothermia. and the need for neonatal resuscitation requiring chest compressions and/or drugs occurs in less than one in 1. The monograph outlines advances in the diagnosis. and the presence or absence of a sentinel event (e. litigation involving encephalopathic newborns who later experienced developmental delays and/or cerebral palsy is one of the most expensive areas of malpractice exposure for obstetricians © 2014 AAP News Downloaded from http://aapnews.D..) are stressed. pediatricians and neonatologists. Historically. early neonatal acid/base status. Neonatal encephalopathy is a relatively infrequent diagnosis. and often by seizures. the only treatment with proven efficacy. review of placental pathology. according to the monograph. FAAP. and Lu-Ann Papile. improving safety The determination that a neonatal encephalopathy is due to an intrapartum process has both medico-legal and patient safety implications. depression of tone and reflexes. along with prompt referral to a center that offers therapeutic hypothermia. increased utilization of placental pathology as a diagnostic tool. the criteria outlined in the first edition have been replaced by a broad analysis that includes evaluation of neonatal signs. In addition. M.e. Diagnostic difficulties Neonatal encephalopathy is a syndrome of disturbed neurologic function in the term or near-term infant manifested by difficulty with initiating and maintaining respiration. and offers guidance on assessing the quality of perinatal care. umbilical cord prolapsed. Litigation involving this condition is an expensive area of malpractice exposure. 2014 .000 term births. fetal or Timely evaluation is critical for newborns with suspected encephalopathy. treatment of neonatal encephalopathy by Jay P. Markers that have high specificity and sensitivity in identifying infants in whom neonatal encephalopathy is due to asphyxia during the intrapartum period are lacking. Reducing litigation. The title was changed to indicate that pathologic outcomes other than cerebral palsy (i. pathophysiology and treatment of neonatal encephalopathy. The monograph. Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology.. the only treatment with proven efficacy. In fact. Because neonatal encephalopathy is rare. uterine rupture. Second Edition. and therapeutic hypothermia as a treatment modality. etc.. Goldsmith. published jointly by ACOG and the Academy. presence/absence of multisystem organ involvement. FAAP The diagnosis and treatment of neonatal encephalopathy are challenging issues that have implications for patient safety and medical liability for obstetricians. all providers need to take proper steps to diagnose and treat newborns who experience these infrequent emergencies. subnormal level of consciousness. updates a 2003 report titled. pathophysiology.g. The report stresses patient safety and the need for timely evaluation of newborns with suspected encephalopathy. the American College of Obstetricians and Gynecologists’ (ACOG) Task Force on Neonatal Encephalopathy completed Neonatal Encephalopathy and Neurologic Outcome.Volume 35 • Number 5 May 2014 www..D.aappublications. including the use of magnetic resonance imaging to assess brain injury.

including placental pathology. and their advice should be sought in determining etiology. Patient safety may be enhanced by performing a root cause analysis of the etiology of neonatal encephalopathy. domized controlled trial) to III (opinions of respected authorities). In litigation. Dr. 2014. The monograph reflects current scientific knowledge on this subject using studies reviewed and evaluated for quality according to the method outlined by the U.ly/1jn2V27.S. visit http://bit. such data do not exist. Previously. Now. • To read the executive summary. Although there has been considerable advancement of knowledge of the processes contributing to neonatal encephalopathy. recognize associated conditions such as seizures. Dr. Both served on the ACOG Task Force on Neonatal Encephalopathy. Specialists in perinatal centers may be the best equipped to perform tests such as placental pathology and neuroimaging.aappublications. improved interpretation of fetal heart monitoring or enhancement of neonatal resuscitation procedures in a hospital. In many instances when litigation is instituted years later. Second Edition. results of drug testing on mother and baby. or refer for therapeutic hypothermia in a timely manner. visit (Pediatrics. pediatricians often are sued. large gaps limit the ability to ascertain the etiology of this condition in many cases. may identify the need for better communication between obstetric and pediatric services. and other laboratory tests that may elicit information that may be present only transiently. Goldsmith Dr. Downloaded from http://aapnews. Papile is immediate past chair of the AAP Committee on Fetus and Newborn.org/ at Pakistan:AAP Sponsored on May 3. diagnose and treat the condition in a timely manner. This process. 2014 .and pediatricians.133:e1482-e1488). The report also calls for updates as knowledge on this topic expands and encourages research in this area to be a high priority for funding and study. this lack of Level I evidence often leads to differing opinions on causation of neonatal encephalopathy from experts testifying for opposing parties. Because human studies in this area of medicine are difficult to perform and sometimes would be unethical. the hospital and obstetric providers were the main targets of litigation. the available evidence often is not at the highest level. Such an analysis would lead to preservation of important information. All references are assigned a level of evidence ranging from I (ran- RESOURCES • To order Neonatal Encephalopathy and Neurologic Outcome. Lawsuits may claim the pediatrician failed to resuscitate the infant properly. Papile Dr. Preventive Services Task Force. hypotension or hypoglycemia. Goldsmith is a member of the AAP Committee on Medical Liability and Risk Management. when properly performed. The task force report calls for use of the term “neonatal encephalopathy” rather than “hypoxic ischemic encephalopathy” until a comprehensive evaluation of the potential causes of encephalopathy is performed.

org/ at Pakistan:AAP Sponsored on May 3. can be found at: http://aapnews. pathophysiology.aappublications.aappublications. appears in the following collection(s): Pediatricians and the Law http://aapnews.1542/aapnews.org/content/35/5/18 References This article cites 1 articles.aappublications.aappublications.org/content/35/5/18#BIBL Subspecialty Collections This article. tables) or in its entirety can be found online at: http://aapnews.aappublications.aappublications.org/cgi/collection/medical_liability_sub Fetus/Newborn Infant http://aapnews.org/cgi/collection/fetus:newborn_infant_sub Permissions & Licensing Information about reproducing this article in parts (figures.aappublications. 1 of which you can access for free at: http://aapnews.org/cgi/collection/pediatrics_and_the_law Medical Liability http://aapnews.35.18 DOI: 10.org/site/misc/Permissions.org/site/misc/reprints. 2014 .Updated monograph outlines advances in diagnosis. along with others on similar topics.xhtml Downloaded from http://aapnews. Goldsmith and Lu-Ann Papile AAP News 2014.aappublications.2014355-18 Updated Information & Services including high resolution figures. treatment of neonatal encephalopathy Jay P.xhtml Reprints Information about ordering reprints can be found online: http://aapnews.