Report outlines causes of NE, CP. (Most Occur Before Labor).

The majority of newborn brain injuries are not the result of birth asphyxia but occur before the onset of labor, according to a comprehensive report released last month by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

The report "Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology" gives evidence that most neonatal encephalopathy (NE) and cerebral palsy (CP) cases originate from developmental or metabolic abnormalities, autoimmune and coagulation defects, infection, trauma, or combinations of these factors.

The report comes at a time when plaintiff's attorneys are blaming the development of NE and CP on problems that arise during labor and delivery. According to the report, however, these conditions are rarely caused by birth asphyxia.

"There are a whole host of causes out there [for NE and CP] ... yet until recently, intrapartum asphyxia got the blame for all of them," said Dr. Gary D.V. Hankins, chair of the ACOG task force that developed the report.

The document was not produced to address the current malpractice litigation crisis. The task force that wrote the report was formed in 1999, well before the crisis began, said Dr. Hankins, professor and vice chair of obstetrics and gynecology at the University of Texas, Galveston.

"Do I believe this one document will change the litigation atmosphere? I'm not quite that naive," he said.

Lisa Miller, a certified nurse-midwife and lawyer who was not on the task force, said the report probably won't decrease the number of malpractice cases involving brain-damaged babies, but in some instances it may help defend health care personnel involved in the labor and delivery.