Outcome after intrapartum hypoxic ischaemia at term.
We consider the range of childhood disabilities that have been attributed to perinatal hypoxic ischaemia at term and review the strength of evidence for each. The strongest evidence is for a causal link between acute profound hypoxic ischaemia and dyskinetic tetraplegic cerebral palsy (CP). Hemiplegic CP is not usually due to a perinatal hypoxic ischaemic insult at term; an important cause is focal cerebral infarction or 'stroke'. Characteristically, diplegic CP is seen in ex-preterm children with periventricular leukomalacia. Ataxic CP is unlikely to be due to perinatal asphyxia. Recent careful follow-up studies have shown that childhood survivors of perinatal hypoxic ischaemia are at risk for cognitive deficits even in the absence of functional motor disorders. There is no evidence that, in isolation, either attention deficit hyperactivity disorder or autism is caused by hypoxic ischaemia. As effective neuroprotective therapies are introduced, notably cooling, it is possible that the prevalence of CP may be reduced.
Rennie
Janet M
JM
UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospitals, Huntley Street, London WC1E 6DH, UK. janet.rennie@uclh.org
Hagmann
Cornelia F
CF
Robertson
Nicola J
NJ
D019958:Attention Deficit and Disruptive Behavior Disorders / Q000209:etiology; D002547:Cerebral Palsy / Q000209:etiology* / Q000503:physiopathology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D004827:Epilepsy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000000981:diagnostic imaging; D007231:Infant, Newborn; D019957:Motor Skills Disorders / Q000453:epidemiology / Q000209:etiology; D007744:Obstetric Labor Complications / Q000503:physiopathology; D011247:Pregnancy; D011859:Radiography; D012307:Risk Factors