The comments of Dr Badawi et al draw attention to some of the ambiguities in the current understanding of potential significant factors associated with peninatal hypoxic-ischemic cerebral injury. Experimental animal data has demonstrated clearly that intrapartum hypoxic-ischemic insult may result in cerebral injury.1,2 However, epidemiologic studies have raised concerns that this relationship may not be as prevalent as was believed earlier.3-5 Nevertheless, it is important to consider that even if only 10% to 15% of cases of cerebral palsy are related to intrapartum hypoxic-ischemic cerebral injury, this would still constitute significantly large numbers in absolute terms.

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