The research, headed by Professor Neil McIntosh of the University of Edinburgh and involving paediatricians, obstetricians and pathologists from throughout Scotland, failed to identify any pointers in the mothers or their pregnancies and labours which could predict the birth of a compromised baby.
These findings, published in the Archives of Disease in Childhood today, (Thursday, 19 August) are expected to help parents and medical professionals who feel they should have noticed problems prior to or during the birth, and could also reduce legal actions taken against doctors and midwives for perceived mismanagement of pregnancy and labour.
Professor McIntosh, who is also a neonatal consultant with NHS Lothian-University Hospitals Division, said: "It has long been known that only about ten per cent of babies dying in the newborn period have problems identified during labour and delivery which require urgent medical intervention and special neonatal care. There has always been anxiety that important signs are being missed in the other 90% and that management during childbirth is negligent in some way.
"In this huge study, we carried out detailed examination on the brains of newborn infants where the parents consented to autopsy: almost two-thirds of the 137 babies involved. Our group has been able to show that in 36 % of babies born early and in 61% of those born at term there is evidence of significant brain damage that had clearly happened before labour began. This is far more common in infants born in an asphyxiated (suffocated) condition.
"All of the full-term infants who had an acidosis (a metabolic disorder); a low mark on the Apgar score, which measures appearance of skin colour, breathing, muscle tone and other factors in newborn babies; and who then went on to have brain problems, had evidence of pre-existing damage. More than half of the babies born with any one of these feature of asphyxia also had evidence of earlier damage."
Professor McIntosh praised the families who helped with the major research project. He said: "We are indebted to the parents who, despite the turmoil surrounding the deaths of their infants and knowing that the results would not personally help them at their time of grief, allowed these detailed investigations to proceed. We intend that this study will lead to more research into the monitoring of pregnancies."
The study was funded by the Chief Scientist Office and by the charity WellBeing. Shirley Farmer, Director of Wellbeing said: "WellBeing is the only national charity which funds vital research into women's reproductive health and at any one time we have some 30 research projects underway. Our overall vision is to bring an end to fear and suffering from women's reproductive health. We welcome wholeheartedly the results of these investigations which signpost the direction for further research and will help shape the way in which pregnant women are cared for in the future."
Journal
Archives of Disease in Childhood