The fetus at the tipping point: modifying the outcome of fetal asphyxia

Abstract

Brain injury around birth is associated with nearly half of all cases of cerebral palsy. Although brain injury is multifactorial, particularly after preterm birth, acute hypoxia-ischaemia is a major contributor to injury. It is now well established that the severity of injury after hypoxia-ischaemia is determined by a dynamic balance between injurious and protective processes. In addition, mothers who are at risk of premature delivery have high rates of diabetes and antepartum infection/inflammation and are almost universally given treatments such as antenatal glucocorticoids and magnesium sulphate to reduce the risk of death and complications after preterm birth. We review evidence that these common factors affect responses to fetal asphyxia, often in unexpected ways. For example, glucocorticoid exposure dramatically increases delayed cell loss after acute hypoxia-ischaemia, largely through secondary hyperglycaemia. This critical new information is important to understand the effects of clinical treatments of women whose fetuses are at risk of perinatal asphyxia.

Novel Coronavirus disease (COVID-19) in newborns and infants: what we know so far

“…However, maternal hypoxemia and fever caused by severe infection can lead to fetal distress, premature delivery and other risks [39]. Therefore, a detailed morphology scan at 18-24 weeks of gestation is indicated for pregnant women with suspected, probable or confirmed COVID-19 infection [40].…”

Challenges and controversies in perinatal physiology

“…Dhillon and colleagues explore endogenous and exogenous factors that modify the fetal adaptation to hypoxia and during recovery that act to increase or decrease injury, including other adverse events such as inflammation, standard clinical therapies such as glucocorticoids given during preterm labour, and maternal illnesses such as diabetes (Dhillon et al . ). The importance of understanding the effect of the in utero environment on the development of the fetal brain, specifically the cerebral cortex, is also explored in detail by Quezada et al .…”

“…This and several other reviews also highlight the importance of large animal models for translation of new knowledge and treatments from the laboratory to clinic (Dhillon et al . ; Ellery et al . ; Lear et al .…”

“…As highlighted in several key reviews, preterm infants are at high risk of mortality and life‐long morbidity, with limited treatments available to prevent or markedly reduce injury or disease (Dhillon et al . ; Ellery et al . ; Mallard et al .…”

“…Despite improvements in obstetric care, hypoxia before or during birth remains a significant risk factor for brain injury and impaired brain development in both preterm and term babies, as highlighted in several reviews (Dhillon et al . ; Ellery et al . ; Mallard et al .…”