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The Four "Not So" Essential Criteria

In 2003, the American Academy of Pediatrics (“AAP”), along with the American Academy of Obstetrics and Gynecology (“ACOG”), published Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology (“NEACP”). The NEACP (or Green Book) sought to identify four “essential” criteria necessary to attribute the events of labor and delivery to neonatal encephalopathy and a subsequent diagnosis of cerebral palsy.

The four so-called “essential” criteria are as follows:

An umbilical cord pH of less than 7 and a base deficit less than or equal to -12; Early onset of severe or moderate neonatal encephalopathy in infants born at ≥ 34 weeks gestation; Cerebral palsy of the spastic quadriplegia or dyskinetic type; and Exclusion of other identifiable etiologies, such as trauma, coagulation disorders, infectious conditions, or genetic disorders.

Although the introduction to the Green Book clearly states that the findings within it are not be used as a body “rigid rules,” the Green Book has been at the center of almost every attempt to defeat a valid birth injury/cerebral palsy claim since its inception.

Thankfully, in the past eight (8) years, medical experts who believe in justice and scientific fact prevailing over “junk science” have lobbied a crusade against debunking the findings within the Green Book – and the criteria have proven not be essential after all. Even one of the primary contributors, Gary Hankins, M.D., has since acknowledged in sworn deposition testimony that the 7.0 ph cutoff is not necessary in all cases.

Many of the cerebral palsy cases prosecuted by Wais, Vogelstein, Forman & Offutt in Maryland, Philadelphia and the District of Columbia do not meet all four (4) criteria. Yet, world-class experts believe that the negligent events of labor and delivery in those cases resulted in our clients suffering catastrophic birth injury, brain damage and cerebral palsy.

The criteria in the Green Book are in no way “essential” and many children born with avoidable hypoxic-ischemic encephalopathy do not meet all four criteria.

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