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Antepartum risk factors for newborn encephalopathy

BMJ 1999; 318 doi: (Published 22 May 1999) Cite this as: BMJ 1999;318:1414

Intrapartum risk factors are important in developing world

  1. Matthew Ellis (, Lecturer in child health,
  2. Anthony M de L Costello, Reader in international child health.
  1. Institute of Child Health, Royal Hospital for Children, Bristol BS2 8BJ
  2. Centre for International Child Health, Institute of Child Health, London WC1N 1EH
  3. Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol BS2 8EG
  4. TVW Telethon Institute for Child Health Research, PO Box 855, West Perth, Western Australia 6872, Australia
  5. Department of Obstetrics and Gynaecology, Hornsby Ku-ring-Gai Hospital, Hornsby New South Wales 2077, Australia
  6. Department of Paediatrics, University of Western Australia, Western Australia 6907, Australia

    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 dysfunction? Other investigators have chosen to exclude established causes of encephalopathy such as overt congenital infection and hypoglycaemia from prevalence studies, so it would be helpful for comparative purposes to know what proportion of the authors' cases had evidence of these.

    Finally, the inclusion of 37 infants with birth defects (23% of the cases) clearly has implications for the subsequent analysis of the likely time of the insult. In a high income setting with almost universal antenatal care and a relatively low stillbirth rate, the live birth …

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