EDITOR, - I wish to raise two points about the study by Geraldine Gaffney and colleagues on intrapartum care and cerebral palsy.1 Firstly, their definition of neonatal encephalopathy - “evidence of neonatal neurological abnormality such as lethargy, coma, impaired respiration, and seizures or changes in tone, or both” - needs clarification. How many of these abnormalities were required to fulfil the definition? Were there any exclusions? I have found that it is difficult to produce an operational definition of this clinical syndrome.

The second point is the analysis of “suboptimal care” in labour. This is important because the scope for preventing neonatal encephalopathy by more interventionist obstetrics is contentious.^2,3 I suggest that the apparently substantial difference between cases and controls …