Antenatal Inflammation and Perinatal Hypoxia

Antenatal Inflammation and Perinatal Hypoxia

 

Karin B. Nelson, of the National Institute of Neurological Disorders and Stroke,  NIH, U.S.A., began her talk by saying that perinatal hypoxia (often referred to as birth asphyxia (BA)) manifests as a series of clinical signs (Figure 4.1). This can lead to the picture of neonatal encephalopathy (NE) However it is clear that NE due to BA is not a major pathway to cerebral palsy in developed countries (Figure 4.2).

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Studies of respiratory depression at birth have described the etiology and manifestations (Figures 4.3, 4.4, 4.5, 4.6, 4.74.8). These include both intrapartum and antepartum events as well as antenatal illness.

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Dr. Nelson reviewed the evidence that maternal infections can cause the syndrome of perinatal asphyxia and NE. There have been numerous studies (Figure 4.9) to determine whether there is evidence of maternal infection in cases where newborns developed evidence of cerebral palsy. In all such studies evidence of maternal infection has been found. Dr. Nelson concluded that intrauterine exposure to inflammation or maternal fever, even when not followed by sepsis in the infant, can cause illness in the newborn (Figure 4.10)

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As noted in Figures 4.8 and 4.11 BA/NE can be caused by many things, including hypothyroidism.

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In summary NE can result from events leading to asphyxia as well as from other causes, especially intrauterine infection. These can be distinguished clinically (Figures 4.12, 4.13).

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