Essential criteria:
(1) presence of metabolic acidosis in the intrapartum fetal, umbilical arterial, or very early neonatal blood (pH < 7.00 and base deficit >= 12 mmol/L)
(2) early onset of moderate or severe neonatal encephalopathy in an infant >= 34 weeks gestation
(3) cerebral palsy of the spastic quadriplegic or dyskinetic type
Additional criteria that individually are nonspecific:
(1) a sentinel hypoxic event occurring immediately before or during labor
(2) a sudden, rapid and sustained deterioration of the fetal heart rate pattern AND a preceding hypoxic event AND a previously normal fetal heart rate pattern
(3) an Apgar score <= 6 for > 5 minutes
(4) early evidence of multisystem involvement
(5) evidence of an acute cerebral abnormality on an early imaging study
If all 3 essential criteria are present, then an acute or chronic intrapartum hypoxic event can be considered.
If only 2 essential criteria are present, then it is likely that an intrapartum hypoxic event was not the cause of cerebral palsy.
If all 3 essential criteria are present and all 5 additional criteria are present, then the intrapartum event was likely acute.
If some of the additional criteria are missing or if there is evidence inconsistent with a significant acute hypoxic event (like a normal Apgar score at 5 minutes), then it is unlikely that an acute hypoxic event occurred and another cause should be sought.
If all 3 essential criteria are present AND if most (4 out of 5) of the additional criteria are present AND if there is no contradictory data, then an acute hypoxic event probably occurred.
