Torbenson VE, et al. - Antepartum and intrapartum factors associated with the development of neonatal hypoxic ischemic encephalopathy (HIE) were searched in this study. Prolonged second stage of labor and the presence of meconium-stained amniotic fluid were reported to be conferring risk for HIE development, therefore, close scrutiny was recommended in labors that develop these features especially in the presence of an abnormal fetal heart tracing. A substantial number of HIE cases were attributed to acute events and it was realized that programs for optimizing the response to these emergencies should be developed by health systems.