A professor of obstetrics at the Univ of California at Davis School of Med, Sacramento, reviewing the relationship of obstetric care and management of asphyxia to the subsequent development of cerbral palsy (CP), refers to his own previously published study at Oxford University [1] and a similar study in progress at the Univ of Newcastle, England. Babies who were at risk for development of CP were compared with matched normal controls. The frequencies of substandard obstetric care were determined in the controls and in all cases of fetal death from asphyxia or trauma, those with severe asphyxia, convulsions in the first 48 hrs of life, and in children recognized to have CP at 18 mo of age.

Quality of care during labor proved to be less important than prenatal care. Substandard care during labor was not related to severe asphyxia, neonatal convulsions, or CP. A delay in the initiation of treatment for diagnosed asphyxia was not observed in CP cases, was uncommon in the control group (1.4%), but was frequent in cases of fetal death (20%), convulsions (7.9%) and severe birth asphyxia (5.4%). Substandard intrapartum care and especially the lack or failure to react appropriately to electronic fetal monitoring was causally related to neonatal seizures but not to CP.

A possible causal relationship of perinatal asphyxia and CP should require the following: (1) severe newborn acidosis, (2) damage to other organs, (3) severe neurologic abnormalities in the first 24-72 hrs. [2]

COMMENT. This review and study tends to confirm the results and conclusions of the Neurological Collaborative Perinatal Project (NCPP) concerning prenatal and perinatal factors associated with brain disorders that only 25% of CP cases may be attributed to asphyxia at birth and that CP is only very rarely preceded by potentially preventable perinatal asphyxia. [3]