Introduction
Neonatal encephalopathy is defined by the American College of Obstetricians and Gynecologists and American Academy of Pediatrics joint Task Force on Neonatal Encephalopathy as a clinical syndrome of disturbed neurologic function in the earliest days of life in an infant born ≥35 weeks of gestation, manifested by a subnormal level of consciousness or seizures, and often accompanied by difficulty with maintaining respiration and depression of tone and reflexes.1 Hypoxic-ischemic encephalopathy (HIE) accounts for a significant proportion of encephalopathic newborns, and despite advances in perinatal care, moderate-to-severe HIE remains a major cause of acute neurological injury and subsequent long-term neurodevelopmental disability.2 While prenatal and/or postnatal complications may cause HIE, studies have demonstrated that the majority of encephalopathic newborn infants sustained brain injury at or near the time of birth.3
The importance of recognition of intrapartum fetal compromise followed by appropriate action is essential to mitigate the presence of effects of hypoxia and avoid subsequent disability. Obstetric leaders have called for improvements in safety and quality assessment4 including initiatives to improve both the recognition of pathological fetal heart rate tracings5,6 and the clinical management of sentinel events which can lead to fetal compromise.7,8 Despite ongoing efforts to minimize the risk of neurological injury at delivery, contemporary data on patient characteristics and clinical events and management of labor preceding HIE is limited. Given that there is a significant knowledge gap regarding clinical events and management during such deliveries, the aim of this study was to undertake a structured review of a large series of deliveries of neonates with HIE.