Encephalopathy

This month we have a lot to say about neonatal encephalopathy. Lally et al report the outcomes of 10 babies with mild encephalopathy who all got cooled; two of them had a poor neurodevelopmental outcome at 2 years. For these observations there are three possible interpretations: in mild encephalopathy, cooling may be harmful, cooling makes no difference, and the criteria for cooling should be extended. Which is right? It’s an important question to answer because Oliveira et al show that there is practice creep across the UK to cool more mildly affected babies which has the potential to cause considerable harm until we know the answer. Perhaps we should first concentrate on identifying accurately those babies for whom there is already good evidence of benefit; Vesoulis et al make a case for universal umbilical cord gas measurement as a way of identifying more babies with at least moderate encephalopathy in a timely fashion. British readers will know that this would be contrary to current NICE guidance. Finally, Gale et al use data from the UK Neonatal Research Database to address the question as to whether diagnosed neonatal brain injury could be …