Most babies who die around the time of birth have lethal deformities, are premature, or have birth asphyxia, a condition in which the child doesn't get enough oxygen during labor, delivery, or immediately after birth. While birth asphyxia isn't necessarily anyone's fault, people are much more likely to blame the obstetrician for asphyxia than for deformities or premature births, say a group of researchers in Edinburgh who studied neonatal deaths in Scotland to find out when birth asphyxia starts.

What the researchers wanted to know: Does birth asphyxia happen because of labor or do babies who die of birth asphyxia already have brain damage?

What they did: The researchers kept track of every baby in Scotland who was born at 24 weeks' gestation or later and died in their first week. They excluded babies who were stillborn, or who had central nervous system problems, heart defects, or any of several other problems. One hundred thirty-seven deaths were analyzed, of which 90 had birth asphyxia and 47 didn't. Two pathologists looked for brain damage in samples taken from 70 of the infants' brains (some of those brains were from babies who died of birth asphyxia and some were not). They said they were able to tell the difference between damage that happened before birth and more recent problems, but only in infants who died on or before their third day.

What they found: Most infants who died of birth asphyxia had prenatal brain damage, including all of those born at term (not premature). The researchers estimate that most babies' damage happened shortly before labor started‑not during labor. Also, they couldn't find anything in the mothers' biographies or the history of the pregnancy that could be used to predict which babies would die of birth asphyxia.

What the study means to you: There's still no way to predict what babies will die of birth asphyxia, and in most cases, babies aren't killed by something that happens during labor. In fact, the authors suggest that the brain damage could even be what starts labor. That could help get doctors off the hook—they often get sued for birth asphyxia deaths.

Caveats: It's very difficult to be definite about when brain damage happened.

Find out more: A little information about birth asphyxia from the University of California–San Francisco.

Read the article: Becher, J.C. et al. "The Scottish Perinatal Neuropathology Study: Clinicopathological Correlation in Early Neonatal Deaths." Archives of Disease in Childhood. September 2004, Vol. 89, pp. F399-F407.

Abstract online: http://fn.bmjjournals.com