Perinatal Brain Damage Causation

Abstract

The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what constitutes a cause, and how it can be identified. We discuss nine potential theoretical misconceptions: (1) too narrow a view of what is a cause (causal production vs. facilitation), (2) extrapolating from possibility to fact (potential vs. factual causation), (3) if X, then invariably Y (determinism vs. probabilism), (4) co-occurrence in individuals vs. association in populations, (5) one cause is all that is needed (single cause attribution vs. multicausal constellations), (6) drawing causal inferences from very small numbers of observations (the tendency to generalize), (7) unstated causal inferences, (8) ignoring heterogeneity, and (9) failing to consider alternative explanations for what is observed. We hope that our critical discussion will contribute to fruitful research and help reduce the burden of perinatal brain damage.

Mechanisms of Perinatal Arterial Ischemic Stroke

“…129,130 The sensitizing effect of systemic inflammation on perinatal brain lesions induced by H-I or excitotoxic insults has been shown but the mechanisms underlying these effects are not yet fully understood, particularly as to how BBB function is altered.…”

Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial

“…30 Antibiotics might therefore be expected to improve clinical outcomes in this situation. There is also increasing evidence that, in addition to preterm birth, intrauterine infection is an independent antecedent of other disability, particularly cerebral palsy 31 and chronic lung disease. 32 Prescription of antibiotics for PROM could prevent neurological and respiratory disability by prolonging pregnancy or by reducing infl ammation.…”

Evidence, illness, and causation: An epidemiological perspective on the Russo–Williamson Thesis

“…These questions have been of great interest to epidemiologists generally, and were perhaps most famously addressed by Sir Austin Bradford Hill, who in 1965 proposed nine "aspects" of an association that one should "especially consider before deciding that the most likely interpretation of it is causation" (Hill 1965). Drawing upon Hill's work, as well as characteristics in support of a causal claim previously published by one of us (Dammann and Leviton 2007), we suggest that any assessment of exposure-outcome evidence should examine at least the following five characteristics:…”