Medico-legal implications of Neonatal Cerebral Palsy and the responsibilities of modern Obstetric-Neonatal Unit
Journal Title: Progressing Aspects in Pediatrics and Neonatology - Year 2018, Vol 1, Issue 4
Abstract
Modern medico-legal evaluation of Neonatal Cerebral Palsy (NCP) demands recognition of Neonatal Hypoxic Ischaemic Encephalopathy (NHIE) as an indispensable proof of peri-partum fetal hypoxia. Without proven NHIE, modern jurisprudence should not even consider obstetric/paediatric liability of causative peri-partum hypoxia of negligence on the grounds of medically responsible fetal/newborn hypoxia leading to Cerebral Palsy. Peripartum hypoxia, which comprises intra-partum hypoxia may result in damage which may with varying degrees of time manifest itself with epilepsy, neuro-developmental delay, cognitive impairment or Cerebral Palsy and the full damage may not be completely assessable before 3-4 years of age. Court cases alleging obstetric/ neonatologist liability may not commence for a number of years, at times even decades after he birth. In the case of Cerebral Palsy, it must be borne in mind that peri-partum hypoxia is not, nowadays, considered as causative in more than 9% of cases, whereas 91% may be due to premature birth, other complications or of undetermined aetiology. Since in many cases, CP litigation may reach Court without screening as to what may be liable from peripartum hypoxia or otherwise, it is crucial that in the hours or days post-birth, all relevant investigations are performed, stored safely and be accessible if and when necessary.It is therefore crucial for the modern birthing Unit, to be conscious of cases where CP is evident or suspected and proceed on an established protocol of action. The usual and universal Apgar scoring, intra-partum cardio-tocographic tracing as well as fetal intra- or peri-partum acid-base and oxygenation status are a must do, but not sufficient investigations, as discussed later. The 21st obstetric/neonatal unit needs must be fully conscious of the medico-legal implications of cases of NCP where causation such as peri-partum hypoxia may, in the future, be cited for basis of medical liability. Where NCP is suspected, all medical/nursing staff must be conscious of a) The early presentation of the condition. b) Underlying causation with special reference to NHIE. c) The criteria of establishing of NHIE. d) Modern management of NHIE. The main scope of this Editorial is to stress the responsibility of the modern birthing Unit with special reference to point three. This is crucial for many reasons, chief of which is the commencement of the right management of NCP. A high degree of suspicion of the potential of the condition must be kept in situations where severe maternal hypotension, especially if protracted (such as in maternal blood loss, abruption placentae, epidural/postural induced hypotension, uterine rupture, coagulopathies ,cardiac complications….) or in proven or likely potential fetal compromise as in umbilical cord prolapse, intra-partum haemorrhage, trauma, genuine fetal distress….).
Authors and Affiliations
George Gregory Buttigieg KM
Keywords
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- EP ID EP580447
- DOI 10.32474/PAPN.2018.01.000118
- Views 65
- Downloads 0
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