The predictive significance of clinical measures of brain injury in the newborn.

Detailed neurological assessment is of major importance for the accurate diagnosis and prediction of outcome of acute hypoxic-ischemic encephalopathy in the term newborn. Because the clinical features of hypoxic-ischemic encephalopathy are nonspecific, the diagnosis of hypoxic-ischemic cerebral injury should be made with caution and only in the context of historical evidence of intrapartum hypoxic-ischemic insult. In the term newborn, the absence of encephalopathy during the first days of life essentially precludes the occurrence of a significant acute intrapartum hypoxic-ischemic insult as the primary etiology of longterm neurological abnormalities. However, hypoxic-ischemic cerebral injury which originates earlier in gestation may result in few, if any, clinical abnormalities during the newborn period. In premature newborns and term infants on complex life support apparatus, neurological examination during the first days of life is of limited prognostic value. In these instances, greater reliance must be placed on other investigations, e.g. neuroimaging, neurophysiological techniques, and biochemical derangements.