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Antepartum risk factors for newborn encephalopathy
Intrapartum risk factors are important in developing worldInverse association of risk may be due to easier delivery with
elective caesarean sectionAuthors' replyIntrapartum risk factors are important in developing world
| The first 150 words of the full text of this article appear below. |
EDITOR
Badawi et al's case-control study of neonatal encephalopathy in
Western Australia shows that clinical evidence of dysfunction of the
central nervous system in newborn infants is associated with a wide
range of disorders.1 For most of their study population these disorders had origins before the onset of labour. We have two
concerns about generalising their findings to other populations: their
definition of neonatal encephalopathy, and the greater importance of intrapartum risk factors for neonatal encephalopathy in poorer populations in the developing world.
The omission of intrapartum criteria from the case definition of
neonatal encephalopathy has been advocated previously and removes an
important bias affecting other studies.2 The
investigators' broad clinical definition of neonatal encephalopathy,
however, makes comparison with prevalence studies in other settings
problematic. For instance, isolated neonatal seizures are difficult to
ascertain clinically.3 What proportion of the 109 infants
reported to have seizures had interictal evidence of neurological
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