Newborn encephalopathy in term infants: Three approaches to population- based investigation

Epidemiological studies of abnormal neonatal neurology-newborn encephalopathy- are of value not only because of their intrinsic interest, but also because newborn encephalopathy as a potential indicator of the quality of intrapartum care needs to be evaluated. As newborn encephalopathy has a closer temporal relationship to the exposures of interest than does cerebral palsy, it would have a significant advantage over cerebral palsy as an index of intrapartum care. However, the proportion of newborn encephalopathy cases which arise in labour needs to be determined accurately before we can contemplate using the occurrence of newborn encephalopathy as such an indicator. Few good epidemiological studies of newborn encephalopathy have been carried out and there are many challenges in elucidating its antecedents. This paper reviews these challenges and briefly describes and contrasts three ongoing studies.