Dear Editor

It is difficult to define what is suboptimal care in some situations. For example a borderline Cardiotocograph can be interpreted differently by different individuals.

Secondly, although not mentioned in the article, it would be interesting to know how the all case notes for the study were acquired. The number of infants with neonatal encephalopathy might be more than 49. It is possible to include all deaths and stillbirths in a region but it may not be the case with encephalopathic infants.

Finally, because the outcome of these studies can be anticipated from the outset, there is scope for harsher judgement on the quality of care provided.