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.