Rare as a Rolls-Royce Silver Cloud on the main street of medical malpractice ¹, potentially negligent management of intrapartum asphyxia needs meticulous assessment.

Even in the minority of cases which have fairly solid evidence on both standard of care and causation, by no means all of the disability and handicap are attributable to missed or delayed intervention.

The very factors, such aspreterm labour andintrauterine growth retardation, which predispose the fetus to intrapartum asphyxia, carry their own toll of damage to the central nervous system.

In the absence of birth asphyxia, infants born more than 8 weeks early are predisposed to bleeding into the brain, specificallyintraventricular hemorrhage, which often results in permanent brain damage, including cognitive deficits and cerebral palsy affecting one side (hemiplegia).

Severity of jaundice which does not permanently affect the mature newborn may cause neurological deficits in those born very early ^{2, 3}. Learning disabilities are commoner, even in the absence of identified episodes of brain injury.

Such extreme preterm infants are similarly prone to a specific form of chronic lung disease ⁴.

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