From the Division of Neonatal-Perinatal Medicine, Loyola University Medical Center, Maywood, Illinois; and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi.
Obstet Gynecol. 2010 Aug;116(2 Pt 1):261-268. doi: 10.1097/AOG.0b013e3181e7d267.
To propose a clinical work-up in term and near-term newborns to address the nine American College of Obstetricians and Gynecologists (the College) and American Academy of Pediatrics criteria to define an acute intrapartum event sufficient to cause cerebral palsy.
We examined our experience as neonatal expert witnesses in 103 closed claims of alleged intrapartum asphyxia with poor newborn outcome over a 21-year period from 1987 to 2008. We estimated how often the clinical components of this proposed work-up were not obtained or recorded in the medical record.
Cord arterial blood gases and placental pathology were not obtained or sent in 38% and 32% of the 103 cases, respectively. Routine neonatal laboratory tests, including a complete blood count with differential, nucleated red blood cells, electrolytes, calcium, coagulation profile, and renal and liver function tests, were frequently absent. Cranial imaging in ultrasonograms, computed tomography, and magnetic resonance imaging were absent in more than 50% of the cases reviewed and were often not scheduled at optimal times.
The medical record of newborns with poor outcomes frequently has a paucity of objective, evidence-based data. This leads to speculation and unethical expert testimony. The protocol will assist in confirming or refuting allegations of intrapartum asphyxia.
III.
提出一项针对足月和近足月新生儿的临床检查方案，以满足美国妇产科医师学会（the College）和美国儿科学会的标准，确定足以导致脑瘫的急性分娩期事件。
我们研究了在 1987 年至 2008 年的 21 年期间，作为新生儿专家证人在 103 起据称的分娩期窒息不良新生儿结局的封闭索赔中的经验。我们估计了在这种拟议的检查方案中，有多少临床检查内容未在医疗记录中获得或记录。
在 103 例病例中，分别有 38%和 32%未获得或未送检脐带动脉血气和胎盘病理。包括全血细胞计数、有核红细胞、电解质、钙、凝血谱以及肾功能和肝功能检查在内的常规新生儿实验室检查也经常缺失。在审查的超过 50%的病例中，头颅超声、计算机断层扫描和磁共振成像均未进行，而且往往未在最佳时间安排。
不良结局新生儿的医疗记录往往缺乏客观的、基于证据的数据。这导致了猜测和不道德的专家证言。该方案将有助于确认或反驳分娩期窒息的指控。
III。
