Brain damage in infants not always tied to delivery

"There's a perception out there that all brain damage in babies is due to the birthing process," says Ernest M. Graham, M.D., lead author of the study and assistant professor of gynecology and obstetrics. "A large amount of current medical malpractice litigation related to obstetrics is based on that premise. Our study demonstrates that very few problems relate to deliveries; the rest could most likely be attributed to other causes, such as the mother's medical history."

The Hopkins study, of nearly 22,000 infants born over an 11-year period, found that only one of 12 babies born with seizures met the American College of Obstetrics and Gynecology's criteria for neurological disease linked to the birthing process: a low Apgar score (a measure of newborns' health that identifies those in need of resuscitation) five minutes after birth, and a high level of acid in the umbilical cord a measure of oxygen deficiency. Seventy percent of the newborns with seizures had no evidence of acidity in the umbilical cord, a finding that argues against the birthing process as the cause of neurological problems.

The study is published in the August issue of the Journal of Maternal-Fetal and Neonatal Medicine. Seizures, the most common and distinctive signal of neurologic problems in the first month of life, affect as many as 6 percent of babies born weighing less than 3.3 pounds, and 0.2 percent of babies weighing 5.5 to 8.8 pounds.

For the current study, Graham and colleagues examined patient records from all babies born at Hopkins between 1988 and 1999. They identified each infant diagnosed with seizures and compared that baby's delivery with a control group composed of the next two healthy babies that were delivered by the same route, at the same age and with similar birthweight. Researchers looked at the babies' Apgar scores at one and five minutes after birth, and reviewed their umbilical cord acid levels.

Of the 13 infants who

Contact: Karen Blum
Johns Hopkins Medical Institutions

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