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Approach to women with a previous child with mental retardation
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Ashima Arora, Minakshi Rohilla
Mental retardation can be secondary to perinatal asphyxia, which is defined as a lack of blood flow or gas exchange to or from the fetus immediately before, during, or after birth. The incidence of significant perinatal asphyxia is highly variable in different parts of the world depending on the care received by pregnant women, ranging from 2 per 1000 births in the developed world to 2 per 100 in developing countries where access to maternal care is limited. This perinatal/birth asphyxia leads to profound neurological sequelae in more than 25% of the affected babies [8]. The majority of cases of birth asphyxia occur intrapartum, although around 20% of cases are antepartum, while rarely, early postnatal events may also contribute to it. Therefore, thorough history of the previous pregnancy that resulted in mental retardation is mandatory for the obstetrician managing the present pregnancy, with special focus on birthing history. History of birth trauma, difficult instrumental delivery, macrosomia, difficult breech delivery, and so on, must be elicited. Also, maternal complications, such as hypertensive disorders of pregnancy, that may lead to placental insufficiency or preterm births leading to developmental delay in the neonate must be asked about. Overall, the most likely cause of perinatal asphyxia must be ascertained. Some causes such as perinatal infections are known not to recur, while others such as untreated Rh iso-immunization may result in cognitive delays, deafness, and cerebral palsy in survivors.
EEG Findings
Published in Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin, Brain Injury and Pediatric Cardiac Surgery, 2019
Gregory L. Holmes, Wypij David, Sandra L. Helmers
Similar conclusions were reached by Holmes et al.29 for a group of 38 infants who had suffered perinatal asphyxia. In this study, besides confirming that the background EEG activity was the important determining factor in the correlation with clinical follow-up, the authors also established that the efficiency of using the EEG as a predictive test was significantly higher than that of using the initial neurological examination. This is an important finding since the clinical repertoire of behavior in the neonate is narrow, making the neurological and developmental examination of rather limited value in the newborn. While more sophisticated techniques have been developed and shown to be effective for the neurological assessment of newborns, these unfortunately are time consuming and are rarely used in clinical practice. Furthermore, Saint-Anne Dargassies,30 as a pioneer in neonatal neurology, wrote in 1979: “Unfortunately, one cannot always ascertain, (in neonates), the location or extent of a lesion, or even its pathology, by clinical examination alone. Thus the goal becomes one of recognizing general CNS dysfunction, either transient or permanent.”
Perinatal asphyxia
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Perinatal asphyxia occurs when a lack of oxygen and acidosis cause organ impairment. Deprivation of oxygen to the brain can occur in two ways: hypoxaemia – a reduction in the amount of oxygen in the blood;ischaemia – a reduction in the amount of blood perfusing the brain.
A 3-year-old child with multi-drug resistant epilepsy responding to pharmacological and nonpharmacological treatments
Published in International Journal of Neuroscience, 2023
A 9-month-old female infant was brought to pediatric neurology department with MDR epilepsy. Her parents reported that there was no consanguinity and the patient was born at 39-week gestation via vaginal delivery with a birth weight of 3210 g. Apgar scores were 1, 5, 5, 5 at 1 min, 5 min, 10 min and 15 min of life, respectively. She had received therapeutic hypothermia with the diagnosis of perinatal asphyxia. Phenobarbital was started due to abnormal aEEG trace. The cranial MRI of the child showed cortical and deep gray matter and widespread white matter involvement. There was volume loss and T2W and FLAIR hyperintensity in the basal ganglia and thalamus, and cystic changes in the putamen bilaterally. Bilateral symmetrical areas of gliosis were seen in deep and subcotical white matter of both cerebral hemisfere as hyperintense on T2WI and FLAIR. There were cystic changes in the periventricular and subcortical white matter at the region of frontal lobe and insula seen as hyperintense on T2 weighted images and hypointens on FLAIR images. Based on the cranial MRI findings, diagnosis of HIE was confirmed (see Figure 1). The infant was discharged when she was 14 days old.
Human wharton-jelly mesenchymal stromal cells reversed apoptosis and prevented multi-organ damage in a newborn model of experimental asphyxia
Published in Journal of Obstetrics and Gynaecology, 2022
Bilge Kocabiyik, Erkan Gumus, Burcin Irem Abas, Ayse Anik, Ozge Cevik
Asphyxia is a significant problem, accounting for about a quarter of neonatal deaths worldwide. Perinatal asphyxia is the absence of blood flow or gas exchange to the foetus just before, during, or after birth. Perinatal asphyxia can cause profound systemic and neurological sequelae due to reduced blood flow and oxygen to a foetus or infant during the peripartum period (Rodríguez et al. 2020). When the placental or pulmonary gas exchange is compromised or completely interrupted, hypoxia or anoxia oxygen deficiency in vital organs accelerates anaerobic glycolysis due to decreased oxygenation in tissues and organs, resulting in lactic acidosis (Sugiura-Ogasawara et al. 2019). In neonatal hypoxic-ischaemic encephalopathy (HIE), neurological damage occurs along with these, and cerebral injury occurs (Hakobyan et al. 2019). Oxidative stress includes macromolecular oxidative damage, induces tissue protein denaturation, DNA damage, and lipid peroxidation, and interferes with the regular metabolic activity of the body, leading to the emergence and development of diseases, such as HIE (Zubrow et al. 2002, Eroglu et al. 2013). Primary biomarkers, such as cytokines, NSE, and GFAP in perinatal asphyxia are essential both in diagnosis and monitoring treatment. Responses of oxidative stress markers and cytokines in perinatal asphyxia may differ according to the treatments and are also used to detect organ damage.
Two Useful Umbilical Biomarkers for Therapeutic Hypothermia Decision in Patients with Hypoxic İschemic Encephalopathy with Perinatal Asphyxia: Netrin-1 and Neuron Specific Enolase
Published in Fetal and Pediatric Pathology, 2022
Ufuk Cakir, Burak Ceran, Cuneyt Tayman
Perinatal asphyxia (PA) results from insufficient availability of oxygen to various organs and tissues of the fetus and newborn in the antenatal and intranatal periods that causes brain hypoxia and ischemia and results in neonatal hypoxic-ischemic encephalopathy (HIE) [1]. Approximately 0.1–0.4% of term newborns experience some degree of PA to PA and may be affected by dramatic complications due to HIE [2]. Brain damage due to asphyxia is the main cause of macrophage infiltration/activation in the perinatal period [3]. The pathogenesis of HIE is highly complex and still poorly understood. Stimulation of pro-inflammatory cascades, neutrophil and monocyte migration, production of cytokines and chemokines into the injured area occurs due to hypoxic-ischemic brain damage. During the hours and days after the injury, leukocyte subsets and local and systemic cytokine production cause injury in the central nervous system (CNS). This immune response is likely to cause secondary injury [4]. Multiorgan dysfunction may develop due to failure to maintain cerebral, cardiac, gastrointestinal, renal, and adrenal perfusion after the perinatal event. There is no current successful and proven therapeutic approach other than moderate therapeutic hypothermia for neuroprotection and targeting immune cells in the developing brain [1,4]. Some studies have shown that the combination of increased cytokines predicts the severity of HIE [5]. Some markers have even been associated with determining the mortality of patients with HIE, their response to hypothermia treatment, and the need for additional treatment [6].