Why it only takes 60 seconds to evaluate your birth asphyxia case?

John Fisher
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Stopping Medical Injustice
Lawyers investigating a cerebral palsy claim are confronted with the prevailing obstetrical view that asphyxia (lack of oxygen to the fetus before birth) rarely causes cerebral palsy and the cause of most cases of cerebral palsy is unknown.  All babies, term and preterm, are at risk for developing irreversible brain damage when they are exposed to asphyxia during labor and delivery.  The risk of brain injury depends on the duration and severity of the asphyxia, and more brain damage occurs with the passage of time.

Asphyxia around the time of labor and delivery can be a cause of cerebral palsy, but the asphyxia must be nearly lethal to be considered a possible cause.  When the delivery of oxygen and nutrition to the brain is interrupted or severely impeded or decreased for a period of time during labor and delivery, the baby's brain can become injured.  It has been estimated that 10% of cerebral palsy in term infants is associated with asphyxia during labor and delivery.

Due to the multiple causes of cerebral palsy, it is crucial to determine whether the baby meets the criteria of brain damage or cerebral palsy caused by the lack of oxygen during labor and delivery--this condition is known as hypoxic ischemic encephalopathy ("HIE").  An important publication to which experts often refer in support of their causation opinions is published by the American College of Obstetricians and Gynecologists (ACOG) on the subject of "Fetal and Neonatal Neurologic Injury", Committee Opinion #197 (February, 1998).  This publication sets forth criteria which ACOG claims must be present before a "plausible link [between birth asphyxia and cerebral palsy] can be made."

One to two newborns in every 1,000 births develop cerebral palsy as a result of brain damage.  The four ACOG criteria to identify infants who were brain damaged as a result of decreased oxygen during labor and delivery are the following: (1) severe acidosis (cord pH level less than 7.0); (2) a five minute or longer Apgar score of three or less;
(3) evidence of neurologic injury, such as seizures, coma or hypotonia, within the first 24 hours of life; and (4) damage to other organs, such as the kidneys or lungs, that is consistent with decreased oxygen.

A very low Apgar score (0 to 3) at 10 minutes is a powerful predictor of cerebral palsy.

Multi-organ dysfunction in newborns is also a good predictor of cerebral palsy.  Fetal asphyxia causes the redistribution of blood from non-vital organs (kidneys) to vital organs (the brain and heart) and the severely asphyxiated newborn will often show evidence of poor functioning kidneys, lungs and other non-vital organs.

Neuroimaging studies of the brain, such as a CT or MRI of the brain, often show swelling of the brain (known as cerebral edema) in newborns injured by lack of oxygen during labor and delivery.  In trying to determine when a newborn sustained brain damage, the most revealing information can be taken from imaging studies of the brain, as there are distinct changes in the brain in response to a lack of oxygen during labor and delivery.

The four factors listed above will prove whether a newborn sustained cerebral palsy as a result of a lack of oxygen during labor and delivery.  For this reason, an evaluation of a newborn's cerebral palsy case is simple: if these factors are met, it will not be difficult to prove that a newborn's cerebral palsy was caused by lack of oxygen during labor and delivery.

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