Anemia of Prematurity - Portal Neonatal

MISCELLANEOUS Section 9 of 10
Medical/Legal Pitfalls:
• Birth asphyxia, birth injury, and perinatal asphyxia are terms often used incorrectly to describe
HIE. This must be avoided, because their improper usage has medicolegal implications.
o Birth injury is a condition in which fetal or neonatal injury has occurred during the
process of birth (ie, during the first and second stages of labor). Examples include
brachial plexus injury; fracture of the clavicle; forceps-induced damage to the facial
nerve or soft tissues; and cuts or bruises from scissors, clips, or scalp monitors.
o Birth asphyxia is similar to birth injury in that asphyxia occurs during the first and
second stages of labor when the fetus was otherwise normal.
o Perinatal asphyxia signifies that asphyxia occurred at any time in the perinatal period,
namely, from conception through the first month of life.
• The AAP and ACOG recommend using HIE because this term accurately describes the
clinical condition, encephalopathy from asphyxia, without implying the time of brain injury. The
AAP and ACOG also advise not using the terms perinatal asphyxia or birth asphyxia because
it is difficult to identify the time of brain injury and nearly impossible to ascertain that the brain
had been "normal" before such injury. These terms are vague and do not reflect all
components of HIE.
• Avoid inappropriate designation of the diagnosis as asphyxia and ascribing asphyxia as a
cause of any neurological symptom. The medical records should contain objective information
on maternal and neonatal history and on clinical findings on the infant.
• The findings from any brain imaging procedures that have been carried out must be included
in the total assessment of the infant's clinical status. The findings of neuroimaging tests and
EEG (if performed) must be documented.
• No diagnostic tests conclusively prove that a given magnitude of asphyxia has led to a specific
neurological injury. Acute perinatal and intrapartum events have been found in only about
20% of children diagnosed as having cerebral palsy.
• Parents must be given realistic explanations about their infant's clinical status and prognosis.
It should be emphasized that, except under controlled experimental conditions, cause-andeffect
is nearly impossible to establish.
• Good medical records are always better than poor medical records: all details about the
infant's status and parental counseling must be documented carefully.
BIBLIOGRAPHY Section 10 of 10
• American Academy of Pediatrics: Relation between perinatal factors and neurological
outcome. In: Guidelines for Perinatal Care. 3rd ed. Elk Grove Village, Ill: American Academy
of Pediatrics; 1992: 221-234.
• Berger R, Garnier Y: Pathophysiology of perinatal brain damage. Brain Res Brain Res Rev
1999 Aug; 30(2): 107-34[Medline].
• de Haan HH, Hasaart TH: Neuronal death after perinatal asphyxia. Eur J Obstet Gynecol
Reprod Biol 1995 Aug; 61(2): 123-7[Medline].
• Depp R: Perinatal asphyxia: assessing its causal role and timing. Semin Pediatr Neurol 1995
Mar; 2(1): 3-36[Medline].
• Gunn AJ, Gunn TR: The 'pharmacology' of neuronal rescue with cerebral hypothermia. Early
Hum Dev 1998 Nov; 53(1): 19-35[Medline].
• Hall RT, Hall FK, Daily DK: High-dose phenobarbital therapy in term newborn infants with
severe perinatal asphyxia: a randomized, prospective study with three-year follow-up. J
Pediatr 1998 Feb; 132(2): 345-8[Medline].
• Latchaw RE, Truwit CE: Imaging of perinatal hypoxic-ischemic brain injury. Semin Pediatr
Neurol 1995 Mar; 2(1): 72-89[Medline].