Intrapartum care and cerebral palsy

EDITOR, - “This week in BMJ” for the paper by Geraldine Gaffney and colleagues referred to a retrospective investigation of 339 children aged 5 years, suffering from cerebral palsy.1 The conclusion that only 6.8% of cases occurred in non-malformed term singleton babies following suboptimal obstetrical care, extrapolated to all patients with cerebral palsy in the region, is not supported by the data.

Nine subjects were born outside the area, 42 had abnormality or unidentified antepartum causes of cerebral palsy, 27 had postnatal causes, and the obstetrical antecedants of 125 were not investigated. There were therefore 205 children born in the area who were investigated, of whom 138 (67%) may have suffered from intrapartum asphyxia.

The obstetrical care of 128 was described in table V, which reveals 59 instances following suboptimal care. The exclusion of 10 mature asphyxiated infants without neonatal encephalopathy cannot be sustained: this assertion is close but not absolute, and it may be underdiagnosed.2

Suboptimal …