ACOG to target neonatal encephalopathy, CP link: Report builds on 1999 consensus statment. (Major Report in the Works).

VAIL, COLO. -- The American College of Obstetricians and Gynecologists is putting the finishing touches on a forthcoming major report on neonatal encephalopathy and cerebral palsy.

"It will be the most authoritative document produced to date on these subjects. It'll be vitally important for those of us who deliver babies for a living," said Dr. Gary D.V. Hankins, who chairs the ACOG task force charged with creating the report.

The document, which has been 2.5 years in the making, will be published this fall, he said at a conference on obstetrics and gynecology sponsored by the University of Colorado.

The past few years have brought major advances in the understanding of the causes of cerebral palsy (CP). Much of this work is summarized in an important 1999 international consensus statement endorsed by ACOG and 14 other medical organizations entitled "A Template for Defining a Causal Relationship Between Acute Intrapartum Events and Cerebral Palsy." This report, which was published in 1999 in the British Medical Journal (BMJ 319[7216]:1054-59, 1999), isn't widely known in American medical and legal circles. The ACOG document builds upon this consensus statement and should get the word out to a wider audience.

"Something has to be stated to put to rest those individuals who get up in court and totally misrepresent the science. That's one of our efforts in this document--to tell the truth as we know it, say where we don't know it, and, in areas where we're getting hammered unnecessarily, to so state that," Dr. Hankins, professor and vice chair of ob.gyn. at the University of Texas, Galveston, explained.

One of the key points to be emphasized in the ACOG report is that there is now broad agreement that neonatal encephalopathy (NE) is a necessary finding in cases of cerebral palsy due to an intrapartum event, he said. If there's no NE, then the cerebral palsy wasn't due to an intrapartum event, and the obstetrician can't rightfully be sued over the bad outcome.

NE is a clinically defined syndrome occurring during the first week after birth of a term or near-term baby. It involves disturbed neurologic function as evidenced by difficulty in initiating and maintaining breathing, an altered level of consciousness, depressed tone and reflexes, and often seizures.