Biological Dimensions of Difference
Christopher J. Nicholls in Neurodevelopmental Disorders in Children and Adolescents, 2018
Neurodevelopmental disorders can have their causation even at this very earliest of developmental stages. If there is a problem with neurulation (the forming of the neural tube) in the third and fourth weeks of life, severe disorders such as anencephaly can occur. Anencephaly refers to the failure of the brain and protective skull to develop and, in most cases, is incompatible with life. Infants born with anencephaly have recognizable faces; however, their heads slope backwards and down from their forehead, and the brain doesn’t develop much above the brainstem and spinal cord. The Centers for Disease Control has ongoing research into the causes of anencephaly and is considering genetic as well as environmental factors (Centers for Disease Control and Prevention [CDC], 2017, August 2).
Epidemiology of Neural Tube Defects
Michele Kiely in Reproductive and Perinatal Epidemiology, 2019
In Glasgow and Liverpool, some of the decline can be attributed to antenatal diagnosis but the impact is limited in Northern Ireland and unlikely to be a factor in Dublin. In Liverpool, the anencephalus/spina bifida ratio increased over the 4-year study period. The authors suggest that this may in part be due to the underrecording of fetuses with anencephalus from pregnancies terminated following diagnosis by ultrasonographic examination,86 but there are no satisfactory data on this. There was no change in the ratio in Dublin, Northern Ireland, or Glasgow. In pooled data from the four centers where a decline was observed, the decline was found in each maternal age group. The proportion of cases delivered to primiparous women remained constant, suggesting that the decline is not explained by prenatal diagnosis applied to women who have had an affected birth.
Grief and the Virtue of Compassion
Aaron D. Cobb in A Virtue-Based Defense of Perinatal Hospice, 2019
Despite recent advances, there is evidence that healthcare providers and medical institutions compound the experience of grief following an adverse in utero diagnosis. Caregivers complicate parents’ grief through careless words and behaviors or through an apparent disregard for the family’s sorrow.3Lang et al. (2011) report that more often than not, bereaved parents receive inappropriate or insensitive care following a perinatal death, even though there are well accepted standards of care that exists in the theoretical and research literature, as well as among professionals in the field.(185)Consider a particularly vivid case.4 Teresa Streckfuss’s son, Benedict, was diagnosed in utero with anencephaly, a neural tube defect that results in the absence of a major part of the brain, skull, and scalp. Anencephalic children typically die within a few hours of birth.5 The individuals who cared for Streckfuss were generally kind but encounters with a thoughtless young doctor compounded her emotional burdens. The physician consistently described the child as nonviable and referred to her as the woman with an ‘anencephalic pregnancy.’ He failed to acquaint himself with the birth plan—a failure Streckfuss ascribes to arrogance.
When Does Consciousness Matter? Lessons From the Minimally Conscious State
Published in AJOB Neuroscience, 2018
Construing the potential for consciousness as morally salient also has what we could call negative ramifications. The reason is that there are classes of individuals that ostensibly lack this potential. Consider anencephalic human infants. The National Institute of Neurological Disorders and Strokes (NIND) describes anencephaly as follows: Infants with this disorder are born without a forebrain (the front part of the brain) and a cerebrum (the thinking and coordinating part of the brain) … A baby born with anencephaly is usually blind, deaf, unconscious, and unable to feel pain. Although some individuals with anencephaly may be born with a rudimentary brain stem, the lack of a functioning cerebrum permanently rules out the possibility of ever gaining consciousness. (National Institute of Neurological Disorders and Strokes n.d.)
A Pandemic Refocuses Bioethics on “The Big Questions”
Published in The American Journal of Bioethics, 2020
Brian M. Cummings, John J. Paris
Three factors were instrumental in this period: technology, third party payment, and the loss of trust in institutions. Intensive care units, ventilators and other potentially life-extending technologies such as dialysis were invented. None would fit into the little black bag. Medical expenses, paid out of pocket, acted as a constraint on demand. With third party coverage, no medical intervention—regardless of price—became beyond consideration. A breakdown of trust in institutions, a multifactorial issue with contributions from research controversies, legal issues of informed consent, and a war in Vietnam, led to a rise of what was labeled ‘patient autonomy.’ At its extreme that position insisted the doctor provide whatever procedure the patient or patient’s proxy desired. Such ‘progress’ was exemplified with the case of Baby K. (In the Matter of Baby K. 16 F.3d 590 [4th Cir. 1994]) in which an infant born without a brain, anencephaly, was, at her mother’s insistence maintained on a ventilator for over two years.
Comparison of Prenatal Ultrasound and Autopsy Findings of Fetuses Terminated in Second Trimester: A Five-Year Experience of a Tertiary Center
Published in Fetal and Pediatric Pathology, 2023
Ezgi Yılmazer Yonder, Murat Cagan, Ozgur Deren, Kadri Safak Gucer
In CNS pathologies, we found neural tube defects and hydrocephalus most frequently by US, while ACC was the most frequent autopsy finding. In the study conducted by Kaiser et al. in 2000, anencephaly and hydrocephalus were found most frequently, followed by neural tube defects [8]. Anencephaly was observed only in one case in our study, and prenatal diagnosis with typical US findings was compatible with the autopsy, as expected. In neural tube defect cases, US and autopsy were compatible in all but one fetus. ACC was not detected by US in 11 cases. In a study investigating CNS pathologies, four (3%) cases were reported that were not detected in US and found ACC in autopsy findings [9]. This discrepancy between prenatal US and autopsy findings may have resulted from the difficulty of detecting the presence of callosal abnormalities by US before the 18th gestational week [10]. Moutard et al. emphasized that ACC may cause symptoms such as seizure, EEG disorder, slow speech, mild cognitive deficit, and prenatal diagnosis was important in such cases [11]. The inconsistency in the findings of microcephaly and macrocephaly in 2 cases in our study did not change the clinical management and was considered a minor discrepancy. Since prenatal US may be limited to evaluating the fetal brain, fetal MRI is mostly used as a complementary tool in cases with suspected migration defects. Two cases in our series with polymicrogyria may not have been diagnosed antenatally due to the early gestational week and limitations of US.
Related Knowledge Centers
- Cognition
- Neocortex
- Neural Tube
- Neural Tube Defect
- Skull
- Cerebrum
- Brain
- Scalp
- Animal Embryonic Development
- Cephalic Disorder