Approach to women with a previous child with mental retardation
Minakshi Rohilla in Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
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
Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin in Brain Injury and Pediatric Cardiac Surgery, 2019
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.”
Neurological problems
Janet M Rennie, Giles S Kendall in A Manual of Neonatal Intensive Care, 2013
The characteristic neurological syndrome seen in term babies after a period of perinatal asphyxia is called hypoxic ischaemic encephalopathy (HIE). The underlying insult is usually a combination of hypoxia and hypotension during late fetal life, resulting in acidosis. The insult can be an acute, profound hypoxia lasting 10–25 minutes (e.g. cord prolapse, uterine rupture) or a chronic partial hypoxia lasting for an hour or more (cord entanglement, uterine hyperstimulation) (p. 30). The diagnosis must be based on more than just a low Apgar score, for which there are many other causes (p. 40). However, in the delivery room the Apgar score may be the only piece of information available. After successful resuscitation, it is helpful to consider the factors in Table 17.2 when deciding whether to admit a baby to the neonatal unit (NNU) for observation (Portman et al. 1990). The clinical picture evolves over the first 12 hours; babies who go to the postnatal ward must be observed carefully because they can, and often do, develop symptoms between 12 and 72 hours after birth.
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.
Correlations of Enzyme Levels at Birth in Stressed Neonates with Short-Term Outcomes
Published in Fetal and Pediatric Pathology, 2018
Junya Nakajima, Norito Tsutsumi, Shonosuke Nara, Hiroki Ishii, Yusuke Suganami, Daisuke Sunohara, Hisashi Kawashima
Transient tachypnea of the newborn (TTN) and meconium aspiration syndrome (MAS) were diagnosed based on risk factors (i.e. meconium staining of amniotic fluid, premature rupture of membranes, and maternal infection) and characteristic chest X-ray findings. Perinatal asphyxia was diagnosed according to perinatal data (e.g., birth following placental abruption or fetal distress) and exclusion of other disorders such as TTN and MAS. At our institution, venous blood samples of either patients born at our institution or at other hospitals are routinely collected at the time of admission to the NICU, not in delivery rooms. Venous blood gas analysis, complete blood count, and blood chemistries, including the intracellular enzymes listed below, are drawn routinely. We collected patient background data, gestational age, birth weight, method of delivery, Apgar scores at 1 and 5 mins, and the duration between birth and the time of blood sampling. We recorded pH, base deficit, and levels of lactate, AST, ALT, LDH, and CK at the time of admission. We evaluated pH, base deficit, and lactate using the ABL800 FLEX (Radiometer, Copenhagen, Denmark), and AST, ALT, LDH, and CK using the VITROS5600 (Johnson and Johnson, New Jersey, USA) and LABOSPECT008 (Hitachi High-Technologies Corporation, Tokyo, Japan), according to manufacturer's instructions. The reference ranges for each parameter shown in the Tables were according to Japanese standards for healthy newborn infants (11).
Acute symptomatic neonatal seizures, brain injury, and long-term outcome: The role of neuroprotective strategies
Published in Expert Review of Neurotherapeutics, 2021
Francesco Pisani, Carlo Fusco, Lakshmi Nagarajan, Carlotta Spagnoli
Refractory seizures are associated with twice the risk of death than those controlled with the initial antiseizure drug loading dose [48]. However, drug-resistance occurs in the most severely affected infants, and status epilepticus is more frequent in critically ill, encephalopathic newborns [27,49]. However, this is unlikely to be the whole story, as standardized treatment protocols have been shown to result in better short-term outcomes, with lower maximum phenobarbital concentrations, lower progression to status epilepticus, and shorter in-hospital stay [51]. It would be noteworthy to know what the long-term outcomes of these babies will be because if an improved prognosis is confirmed, this would mean that by applying more rigorous protocols we will be able to address the modifiable amount of brain injury possibly directly linked to the effect of ongoing seizures. An independent role for seizures on outcome has been suggested by clinical research. The relative risk for adverse outcome in neonates with perinatal asphyxia was 8.41 (4.07–17.39) and for neonates with stroke was 4.95 (1.07–23.0) when suffering neonatal seizures compared to newborns with the same types of brain injury but no seizures [52].
Related Knowledge Centers
- Blood Pressure
- Gastrointestinal Tract
- Intellectual Disability
- Lung
- Liver
- Spasticity
- Heart
- Kidney
- Brain Damage
- Global Developmental Delay