Identifying Causes of Newborn Brain Injury May Lead to Prevention Strategies
Washington, DC—Identifying the root causes of brain injury in newborns may help patient safety efforts to prevent cerebral palsy and other neurologic problems in infants, according to a joint Task Force Report on Neonatal Encephalopathy and Neurologic Outcome by The American College of Obstetricians and Gynecologists (The College) and the American Academy of Pediatrics (AAP).
The task force report recommends a broad evaluation of all potential contributing factors in every case of neonatal encephalopathy, including maternal medical history, obstetric and intrapartum factors, and placental pathology. This recommendation is a shift from the 2003 report, which focused on determining whether or not a hypoxic-ischemic event (lack of oxygen to the fetus around the time of birth) was the cause of neonatal encephalopathy.
“We know that neonatal encephalopathy is a brain disorder with a variety of causes,” said Mary E. D’Alton, MD, chair of the task force and a maternal-fetal medicine specialist at Columbia University Medical Center in New York. “Metabolic disorders, inflammations and infections, genetic conditions, and oxygen deprivation to the infant are all potential causes, but we don’t know how many cases are preventable. By doing a root-cause analysis, we hope to identify issues that may help prevent some cases of neonatal encephalopathy in the future.”
Almost four years in the making, the scientific, peer-reviewed task force report was reviewed by an extensive list of experts from across the US and internationally, as well as consultants from the US Centers for Disease Control and Prevention and the National Institute of Child Health and Human Development. The document is endorsed by a dozen organizations, including the Japan Society of Obstetrics and Gynecology, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada.
“We see this report as a safety document,” said Jay P. Goldsmith, MD, AAP liaison to the task force and a pediatrician at Tulane University in New Orleans, LA. “It covers complete evaluation of all babies who are encephalopathic at birth and, if there are safety issues that we can identify, how to try to correct them.”
“Although a significant portion of newborn brain injuries are due to problems around the time of labor and delivery, some cases occur before the pregnant patient even arrives at the hospital and the labor floor,” explained Dr. D’Alton.
The new report also reflects a medical milestone in the treatment of neonatal encephalopathy. Neonatal hypothermia treatment cools a newborn’s body temperature from 98.6 degrees to 92.3 degrees for 72 hours, which helps minimize long-term brain damage. There have also been significant advances in newborn brain imaging that provide a more accurate determination about the timing of an infant’s brain injury as well as the severity of it. “The benefits of both of these advances are highly dependent on prompt recognition of neonatal encephalopathy,” noted Dr. D’Alton. “Milder cases of newborn brain injury may not always be recognized, so education is key.”
The new report emphasizes the involvement of pediatric expertise. “Now there’s more emphasis on pediatricians taking more responsibility in identifying newborns with brain injury,” said Dr. Goldsmith. “There are approximately 3,000 US hospitals and birthing centers that deliver babies, but only 1,000 of them have neonatal intensive care units. Health care providers at the other 2,000 hospitals are responsible for providing treatment or referring to a center that is capable of providing therapeutic hypothermia. That‘s the pediatric side of the responsibility.”
The new Task Force Report on Neonatal Encephalopathy and Neurologic Outcome is a presidential initiative of Richard Waldman, MD, a past president of The College.
The Executive Summary of the task force report is published in the April issue of Obstetrics & Gynecology and will also be published in the May issue of Pediatrics. The full report is available online to ACOG members. Nonmembers may obtain the report at sales.acog.org.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org
The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. (www.aap.org)