[Cerebral damage in the full-term newborn infant. Causes and outcome]

Modern obstetrics can no longer be content to statistically analyse deaths only but must also concern itself with injuries. Cerebral damage in the new-born at term may result in grave sequelae. A study was made in the maternity department of the Port-Royal hospital of 65 infants, born at 38 weeks or later, with neurological signs, over the period 1968/69. The study was aimed at clarifying neonatal neurological signs, analysing the obstetric circumstances in which the complications occurred and observing future development of the children involved. In most instances a combination of neurological signs was present, falling into three broad clinical categories on the basis of severity. These neurological signs may appear during the hours after birth even when the Apgar score was satisfactory. Analysis of the cases showed that obstetric factors were responsible for the neurological disorder in 45 cases. The obstetric circumstances were almost always identical: abnormalities of presentation, dynamic problems during labour, and trials of labour. Modern methods for in-utero foetal surveillance are excellent but can nerve replace a perfect and hard won understanding of basic obstetric principles. Follow-up showed that sequelae remained in 7 children. It would appear, then, that in addition to "high risk" pregnancies, there exist "high risk" deliveries in part unpredictable before the onset of labour. There exists also a group of children in whom risk is increased and in whom surveillance over many years is indicated.