Perinatal Asphyxia: Looking Back to Move Forward

Abstract

Brain injury due to oxygen deprivation around birth (perinatal asphyxia) is one of the leading causes of neonatal death and impairment worldwide. Currently, the only available treatment to prevent or limit brain injury is therapeutic hypothermia, which involves cooling the newborn to a body temperature of 33.5 °C for 72 hours. Unfortunately, not all newborns with perinatal asphyxia qualify for this treatment, and a significant number of newborns treated with hypothermia suffer from long-term neurodevelopmental problems despite this treatment. This PhD research explored ways to further improve the care and outcomes of newborns affected by perinatal asphyxia by examining current clinical practices, exploring the role of brain imaging for prognostication, and evaluating the long-term neurodevelopmental outcomes. The findings highlight the importance of adequate monitoring and supportive care on the NICU to prevent brain injury following perinatal asphyxia: some newborns with a rapid recovery after resuscitation who did not receive hypothermia treatment were later found to have brain injury, and low blood glucose levels in newborns treated with hypothermia were associated with additional brain injury. The assessment of the presence, extent, and specific locations of brain injury on MRI obtained within the first days after birth can aid in the prognostication. At the same time, the research emphasizes the need for long-term follow-up, as the sequelae of brain injury due to perinatal asphyxia —such as problems with cognition and behavior—may not become apparent until school age. Questionnaires completed by children (aged eight years and older) who were treated with hypothermia as newborns, and their parents, demonstrated that many of them experience difficulties in motor function, cognition, and behavior—particularly with attention and memory. However, the children and their parents also reported their strengths in personality and talents in sports and other hobbies. This emphasizes that future research should not only focus on preventing brain injury after perinatal asphyxia, but also on strengthening the resilience of the children and their families.