Authors’ reply to Lees

As Lees mentions,^{1 2} children whose births were monitored electronically had significantly fewer seizures in the newborn period.³ Most data on fetal monitoring and neonatal seizures come from the large Dublin study.⁴ The meaning of this association is far from clear, as there were no more cases of cerebral palsy in the auscultation only group.^{3 5} Moreover, of the 39 surviving Dublin infants who had had neonatal seizures, six had cerebral palsy at age 1, three in each monitoring group. Thus outcome did not differ according to method of monitoring in labour among those with neonatal seizures⁶ or the total.^{3 5}

Neonatal seizures have many potential causes, including infection, toxins, malformations, metabolic derangements, and perinatal stroke. We cannot accept Lees’ assumption that, in the fetal monitoring trials, “most of these seizures are hypoxic in origin and due to intrapartum events” because neonatal seizures that are due to acute intrapartum hypoxic-ischaemic events are usually accompanied by low Apgar scores, cord blood acidosis, and need for special nursery care.⁵ None of these findings occurred more often in infants monitored by auscultation only, nor was perinatal mortality higher or long term neurologic morbidity more frequent.³

The long term effects of preventable neonatal seizures remain unknown,³ while the known effects of electronic fetal monitoring—more surgical deliveries with their associated risks, higher costs, and more litigation—are well established.²