Summary: Midgestational sheep fetuses exposed to marked hypoxia for 2 h remain brain intact if MABP is maintained above 30 mm Hg. On the other hand, simi larly hypoxic fetuses, if they experience reductions in MABP below 30 mm Hg, develop foci of necrosis that predominantly affect hemispheric white matter and neo striatum. Cortex damage is more restricted and is usually associated with more massive underlying white matter damage. The present study examines the brain metabolic basis for the important role of hypotension in brain injury development in marked hypoxia. Sheep fetuses rendered hypoxic by respiring their ewes with 11 % oxygen (fetal PaOZ = 8-12 mm Hg) in which MABP was maintained above 30 mm Hg showed increases in brain lactic acid concentrations to 7 -13 f,Lmollg but unaltered energy charge. In contrast, fetuses that sustained MABP reduc tions below 30 mm Hg showed increases in lactic acid Fetal or neonatal hypoxic-ischemic encephalo pathy is commonly thought to result from an im paired oxygen supply to brain due to a decreased oxygen content of arterial blood and/or a decrease in CBF. Such asphyxia in utero, in contrast to various postnatal insults, is the predominant cause of "cerebral palsy," a syndrome that encompasses a variety of motor deficits and in which mental re tardation and epilepsy may or may not be present (Volpe, 1981).The neuropathology of perinatal hypoxic-isch emic encephalopathy includes selective neuronal Received July 8, 1985; accepted March 25, 1986. Address correspondence and reprint requests to Dr. K. R. Wagner at Veterans Administration Medical Center, Medical Research Service/15I , 3200 Vine Street, Cincinnati, OH 45220, U. S. A.
425concentrations in vulnerable structures to 16-24 f,Lmol/g accompanied by marked decreases in energy charge. The vulnerable structures also showed reductions in fructose concentrations but a variable behavior of other brain me tabolites including phosphocreatine, glycogen, and glu cose. Thus, the present findings suggest a relation be tween hypotension during marked hypoxia, low energy charge, lactic acid accumulation in brain at high concen trations, and fetal brain injury. The ewes of hypoxic hy potensive fetuses received pentobarbital at lower doses than did those of fetuses that maintained blood pressure. This suggests that pentobarbital plays an important role in protecting the fetal brain from asphyxia by extending the hypoxic fetus's ability to maintain blood pressure in addition to reducing its brain metabolism.