BMJ 1996;312:580 (2 March)

Letters

Measures used in study are hard to interpret

EDITOR,--Stuart J Anderson and colleagues' study of the predictors of neonatal encephalopathy in full term infants1 is timely in view of changes and practices in Britain and trends in litigation. It is worrying, however, that serious problems with interpretation are known to arise with several of the measures of intrapartum events used in the study to indicate birth asphyxia and subsequent neonatal encephalopathy.

Cardiotocographic appearances are poorly correlated with asphyxia, and serious acidosis can occasionally be present with "normal" tracings.2 Likewise, meconium staining has an imprecise correlation with outcome.

The Apgar score can be normal at delivery despite the presence of severe fetal acidosis,3 and there is documented evidence that babies with "normal" Apgar scores have collapsed hours after delivery and developed neonatal encephalopathy.

It is imprecise to use cord pH without specifying whether the blood is of arterial or venous origin. Cord gas analysis of the umbilical artery and . . . [Full text of this article]


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Relevant Article

Predictors of neonatal encephalopathy in full term infants
Stuart J Adamson, Louisa M Alessandri, Nadia Badawi, Paul R Burton, Patrick J Pemberton, and Fiona Stanley
BMJ 1995 311: 598-602. [Abstract] [Full Text]

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