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Updated: Aug 5, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The neurologically impaired child and alleged malpractice at birth
1Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA. knelson@helix.nih.gov
Insights
Understanding developmental disabilities has improved, revealing a smaller role for birth asphyxia. Intrauterine factors like infection and multiple pregnancies are key risks for cerebral palsy, not C-sections.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Epidemiology
Background:
- Advances in controlled studies and biological understanding enhance insights into fetal and neonatal brain injury.
- The etiology of developmental disabilities is becoming clearer, though still not fully elucidated.
Purpose of the Study:
- To re-evaluate the causes of developmental disabilities, focusing on birth-related factors and intrauterine influences.
- To assess the effectiveness of current monitoring techniques and interventions during childbirth.
Main Methods:
- Review of controlled studies and epidemiological data.
- Analysis of biological mechanisms underlying fetal and neonatal brain injury.
- Evaluation of electronic fetal monitoring and caesarean section efficacy.
Main Results:
- Asphyxia during birth plays a less significant role in developmental disabilities than previously thought.
- Intrauterine infection, autoimmune disorders, coagulation issues, and multiple pregnancies are identified as risk factors for cerebral palsy.
- Electronic fetal monitoring demonstrates high false-positive rates, limiting its utility.
- Caesarean section does not prevent cerebral palsy in term infants.
Conclusions:
- The understanding of developmental disabilities has advanced, shifting focus from birth asphyxia to intrauterine factors.
- Current intrapartum monitoring and interventions like caesarean section are not effective in preventing cerebral palsy.
Abstract:
Controlled studies, improved epidemiologic and statistical techniques, and an increase in biological information on mechanisms of fetal and neonatal brain injury or maldevelopment have led to a better, although still imperfect, understanding of the cause of developmental disabilities. The role of asphyxia during the birth process is smaller than was once believed. Intrauterine exposure to infection, autoimmune and coagulation disorders, and problems specific to multiple pregnancies are risk factors for cerebral palsy. Electronic fetal monitoring and other observations during birth are unsatisfactory management guides, having enormously high rates of false-positive identification. There is no evidence that caesarean section can prevent cerebral palsy in term infants.
