Expert Witness in Neonatal Medicine: Dr Michael Munro on Causation, Resuscitation and Medical Negligence

12th Feb 2026
Neonatal injury litigation sits at one of the most complex intersections of medicine and law. Establishing causation in cases involving birth asphyxia, hypoglycaemia, or long-term neurodevelopmental conditions requires not only clinical expertise but a rigorous understanding of evolving scientific evidence and multidisciplinary care pathways. Dr Michael Munro, consultant neonatologist and founder of MJM Medico Legal Services, has spent over two decades working at the frontline of neonatal intensive care. In addition to leading clinical teams and contributing to hospital design, he provides independent expert opinion in complex perinatal and neonatal negligence cases. In this interview, Dr Munro discusses how neonatal care has evolved, the recurring themes in birth injury litigation, and the challenges of presenting clear, balanced medical evidence in court. Q&A with Dr Michael Munro Dr Michael Munro, founder of MJM Medico Legal Services, provides independent expert opinion in complex neonatal and perinatal negligence cases. How has neonatal intensive care evolved over the past two decades, and how has that shaped your clinical and expert witness practice? Neonatal intensive care is an intensely hands-on specialty. Multiple resuscitations can occur in a single day, and the immediacy of those situations — where decisions made in minutes can affect an entire lifetime — is something I have always found both challenging and rewarding. Over the years, neonatal care has evolved significantly. Historically, the emphasis was primarily on survival and acute clinical stabilisation. Today, we take a far more holistic approach, incorporating developmental care and recognising the impact of environment and parental interaction on neurological outcomes. One major development has been transitional care, where mothers and babies remain together even when the baby has medical needs. This promotes bonding and strengthens the family unit while still providing appropriate clinical oversight. My own role has evolved from junior team member to clinical leader. Over the past decade, I led the design and construction of Aberdeen’s Baird Family Hospital, which includes a Level 3 neonatal unit built around family-centred principles. How has your research into autism and perinatal injury influenced the way you assess causation in complex negligence claims? Through long-term follow-up of neonatal graduates, it became increasingly apparent that while some preterm or asphyxiated infants avoid conditions such as cerebral palsy, they may later develop behavioural or cognitive difficulties. Autism is a particularly complex example. The aetiology is generally considered to involve both genetic and environmental components, and the scientific literature continues to evolve. In researching this area extensively, I was struck by how broad an expert’s knowledge base must be — and how important it is to remain current. For an expert witness, it reinforces the importance of evidence-based reasoning. Medical understanding is not static. An opinion must reflect contemporary science, not historical thinking. In neonatal resuscitation cases, how do you assess whether the standard of care and competency requirements were properly met? Completion of resuscitation courses alone does not establish competence. In the UK, Newborn Life Support (NLS) and the Neonatal Resuscitation Program (NRP) internationally both emphasise that validation does not equal competency. Competency comes from supervised clinical application. Trainees must undertake formal training and then apply those principles under senior supervision, with structured feedback and debriefing. When assessing a case, I examine whether appropriate training was completed, whether supervision was available, whether recognised protocols were followed, and whether there was effective post-event reflection. Simulation training now also plays a crucial role. Modern high-fidelity simulation allows realistic rehearsal of emergency scenarios and is essential for maintaining safe practice. Why is establishing causation particularly complex in perinatal injury litigation, especially where timing and mechanism are disputed? Many cases are perinatal rather than purely neonatal, meaning obstetric and midwifery perspectives are equally important. As a neonatologist, I am often asked to determine causation for injuries that may have originated before birth or during labour. Establishing timing and mechanism requires careful review of antenatal history, intrapartum events, neonatal condition, biochemical markers, and imaging. Neuroimaging frequently forms part of the evidence, but interpretation of CT or MRI scans may require specialist neuroradiology input. Genetic and metabolic testing is also increasingly relevant. The challenge lies in synthesising multiple strands of evidence coherently and remaining within one’s own area of expertise. What patterns are you seeing in current neonatal medical negligence claims, and how are these trends influencing expert opinion on causation? Avoidable hypoglycaemia remains one of the most common causes of neonatal litigation. Brain injury resulting from untreated or inadequately managed low blood sugar continues to arise, often linked to protocol failures or gaps in knowledge. More recently, I have been involved in a growing number of cases concerning autism and alleged links to perinatal events. With rising diagnosis rates, questions around causation are increasingly common in litigation. These cases are medically and legally complex, particularly where causation is disputed. How should courts weigh evolving scientific evidence when assessing causation in cases involving neonatal brain injury and autism? Scientific evidence is essential, but it is rarely absolute. In cases of long-term neurodevelopmental impairment, neuroimaging may provide limited clarity regarding causation. Conventional MRI cannot diagnose autism and cannot determine how it developed. At the same time, MRI may demonstrate evidence of perinatal asphyxia, and epidemiological studies suggest such events increase the risk of later neurodevelopmental issues. Emerging imaging techniques — including 3D volumetric MRI, diffusion tensor imaging (DTI), functional MRI (fMRI), and magnetic resonance spectroscopy (MRS) — may provide greater clarity in the future, potentially supported by artificial intelligence. Until then, courts must often rely on epidemiological data rather than definitive imaging findings. How do you present complex neonatal evidence in a way that is clear, balanced and accessible to the court? Clarity is critical. Medical terminology, abbreviations, and statistical analysis can easily overwhelm a non-clinical audience. I prepare structured reports that explain terminology carefully and avoid unnecessary jargon. Analogies drawn from everyday life can help clarify complex mechanisms. Where statistical evidence is involved, particularly in meta-analyses, it is essential to understand precisely what the data does — and does not — demonstrate. An expert’s duty is not only to provide an opinion but to ensure it can be understood. What issues are most commonly underestimated in neonatal negligence cases? Complete documentation is essential. Maternal obstetric records are often critical, particularly resuscitation records and antenatal history. It is also important to involve appropriate experts at the correct stage. In alleged intrapartum asphyxia cases, obstetric expertise is typically required to address liability, while neonatal expertise informs causation and postnatal management. Early multidisciplinary expert involvement — before formal proceedings are issued — can significantly strengthen case preparation and ensure no relevant breach of duty is overlooked. Closing Reflections on Causation and Courtroom Clarity Neonatal medical negligence cases demand precision, balance, and multidisciplinary awareness. As Dr Michael Munro’s experience demonstrates, determining causation in birth injury claims requires not only clinical expertise but a careful synthesis of evolving scientific evidence. In one of healthcare’s most sensitive and high-stakes fields, the expert witness plays a vital role in helping courts navigate complexity with clarity and objectivity. People Also Ask What is neonatal injury litigation?Neonatal injury litigation involves medical negligence claims arising from care provided before, during or shortly after birth, often involving brain injury, hypoglycaemia or asphyxia. How is causation proven in birth injury cases?Causation is typically established through a combination of medical records, expert testimony, neuroimaging, biochemical markers, and epidemiological evidence. Can MRI scans prove autism was caused by birth injury?Conventional MRI cannot diagnose autism or determine its cause. Courts often rely on epidemiological data rather than definitive imaging findings. What is the most common cause of neonatal negligence claims?Avoidable hypoglycaemia and delayed recognition of perinatal asphyxia remain common causes of neonatal brain injury litigation. Who provides expert evidence in neonatal brain injury cases?Neonatologists, obstetricians, neuroradiologists and sometimes genetic specialists may all contribute expert opinion depending on the issues in dispute.