Donn Steven M, Chiswick Malcolm L, Fanaroff Jonathan M
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
Centre for Pediatrics and Child Health, University of Manchester, UK.
Semin Fetal Neonatal Med. 2014 Oct;19(5):317-21. doi: 10.1016/j.siny.2014.08.005. Epub 2014 Aug 20.
Medical malpractice litigation in the USA and much of the developed world has reached near-epidemic proportions. Brain-damaged infants are among the most costly medical malpractice lawsuits, with the average indemnity for these cases being $524,047. Hypoxic-ischemic encephalopathy (HIE) is the most common birth injury claim, generally alleging that intrapartum asphyxia led to long-term neurologic sequelae, including cerebral palsy and/or developmental delay. Timing of injury is a key element in the legal arena. The plaintiff will try to prove that injury occurred in the intrapartum period, whereas the defense may argue that it occurred prenatally. A recent American Academy of Pediatrics/American College of Obstetricians and Gynecologists Task Force on Neonatal Encephalopathy developed a checklist that needs to be fulfilled in order to establish a reasonable causal link between an intrapartum asphyxial insult and subsequent long-term neurologic disability. Therapeutic hypothermia has been shown to benefit certain infants born with moderate to severe HIE by improving neurologic outcomes. Since the advent of hypothermic neuroprotection, new malpractice allegations have arisen, including the failure to refer a baby for cooling and failure to initiate cooling in a timely manner. In all cases, documentation of the status of the baby at birth, including a thorough neurologic exam, can be extremely helpful to the later defense of a malpractice claim, which might occur years later.
在美国和许多发达国家，医疗事故诉讼已达到近乎泛滥的程度。脑损伤婴儿是医疗事故诉讼中代价最高的群体之一，此类案件的平均赔偿金为524,047美元。缺氧缺血性脑病（HIE）是最常见的出生损伤索赔案由，通常指称产时窒息导致了包括脑瘫和/或发育迟缓在内的长期神经后遗症。损伤时间是法律领域的一个关键因素。原告会试图证明损伤发生在产时，而被告可能辩称损伤发生在产前。美国儿科学会/美国妇产科医师学会新生儿脑病特别工作组最近制定了一份清单，要在产时窒息性损伤与随后的长期神经残疾之间建立合理的因果关系，就必须满足这份清单的要求。治疗性低温已被证明可通过改善神经结局使某些患有中度至重度HIE的婴儿受益。自从低温神经保护疗法出现以来，出现了新的医疗事故指控，包括未能将婴儿送去进行降温治疗以及未能及时开始降温治疗。在所有情况下，记录婴儿出生时的状况，包括进行全面的神经检查，对多年后可能发生的医疗事故索赔的后期辩护会非常有帮助。
