Perinatal asphyxia and cerebral palsy: fact, fiction or legal prediction?

Article Abstract:

The public and the legal system are conditioned to the notion that when brain damage occurs in newborns, and cerebral palsy results, someone must be blamed. Pediatricians remain at risk for suits which attempt to establish that they, or the obstetrician, erred in some way that caused this unfortunate outcome. The plaintiff's lawyer must show that medical care fell below some accepted standard and that, as a result, the child developed cerebral palsy. Cerebral palsy is defined as a nonprogressive motor problem caused by damage, or a lesion, within the nervous system. The exact location of the lesion and its time of production are responsible for the unique type of motor impairment seen in each case of cerebral palsy. A study presented in the October 1989 issue of the American Journal of Diseases of Children provides important evidence that cerebral palsy is usually not the result of birth trauma or other neonatal injuries, but is the consequence of intrauterine difficulties which are not preventable. There has been much confusion in the literature regarding the association of cerebral palsy with difficult birthing (such as occurs in breech birth). This analysis of 60,000 pregnancies indicates that difficult birthing may itself be a consequence of untoward events of intrauterine development. The pediatrician has a role in preventing the continuance of malpractice suits which are filed as a consequence of needing to blame someone for a child's cerebral palsy. Pediatricians should exercise caution by providing objective documentation of a newborn's health status. The pediatrician must actively aid the legal profession, other physicians, and the public-at-large to gain insight into the possibility that, when the outcome of pregnancy is not perfect, perhaps no individual is responsible. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Origins of cerebral palsy

Article Abstract:

The major causes of cerebral palsy were researched using a massive database prepared by the United States National Institute of Neurological and Communicative Disorders and Stroke. Cerebral palsy was defined as a chronic neurological disorder involving abnormal control of movement or posture that occurs early in life and does not progress. This prospective study of 43,437 full-term infants identified 34 quadriplegic and 116 nonquadriplegic children who suffered from cerebral palsy. Significant events attending to the pregnancy, labor, delivery, and early postnatal period of the infants were recorded and developmental progress was evaluated up to seven years of age. Twenty-three infants were diagnosed with cerebral palsy before the age of one, and the remaining 127 children were diagnosed by the age of seven. The 150 cases of cerebral palsy ranged from mild to severe. The data suggest that 53 percent of the 34 quadriplegic children suffered from cerebral palsy as the result of congenital disorders, and that only 14 percent of the cases of quadriplegia were caused by asphyxia, or decreased oxygen supply, during the birthing process. In the less severely afflicted group, 35 percent of the cases were attributed to congenital problems and 6 percent to other disorders. Only 9 of the 150 cases of cerebral palsy were caused by birth asphyxia (6 percent). Congenital disorders were responsible for nearly four times as many cases of quadriplegic cerebral palsy than birth asphyxia. Contrary to popular opinion, these data suggest that most cases of cerebral palsy do not result from a reduced supply of oxygen during a difficult birth. To validate a correct diagnosis of birth asphyxia, the importance of accurate documentation of measurements and observations of newborns is stressed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cerebral ischemia

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The eighty-hour workweek: residency friend or foe

Article Abstract:

Following the death of Libby Zion, a New York hospital patient, and the investigation that linked her death to the excessive work week of hospital residents, restraints on the working hours of hospital physicians (80 hours/week) were legislated by that state. There is no question that the residency period is extremely stressful, and that medical students were never promised an easy life, but evidence has been mounting that residents all to often suffer from emotional crises and depression. The clear message is that the conditions and expectations of resident training programs must change to allow the process of physician education to continue, but without the sacrifice of the student's mental and physical health. Cutting down on the permissible hours of weekly work creates a staffing problem for hospitals. The lack of staff can be made up by mechanism besides obtaining more residents. Possibilities include the use of more fully-trained staff doctors and nurse practitioners. While there will always be need for nights on call and the stress of sleepless nights for residents, there must also be concern for the emotional and physical well-being of those being trained. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Evaluation, Cases, Residents (Medicine), Quality of work life, editorial, Zion, Libby

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