title: Changing pattern of perinatal brain injury in term infants in recent years.
abstract: Perinatal brain injury in term infants remains a significant clinical problem. Recently a change appears to have occurred in the pattern of such injuries. We sought to characterize the incidence, etiology, clinical manifestations, and outcomes of these injuries. A retrospective chart review identified clinical characteristics of neuroimaging, electroencephalography, and placental pathologic findings. Perinatal depression was defined as hypotonia and the need for respiratory support. From January 2004-December 2009, 29,597 term deliveries occurred. Brain injuries in 33 infants (live term births) included hypoxic-ischemic encephalopathy (n = 8; 0.27/1000), subdural hemorrhage (n = 10; 0.34/1000), intraventricular/intraparenchymal hemorrhage (n = 5; 0.17/1000), and focal cerebral infarctions (n = 4; 0.14/1000). Thirteen of 33 infants (39%) were triaged to a regular nursery. Delayed presentations included apnea (n = 6), desaturation episodes (n = 3), and seizures (n = 4). Twenty of 33 (61%) were admitted directly to the neonatal intensive care unit because of perinatal depression or evolving hypoxic-ischemic encephalopathy. Clinical signs included seizures (n = 12) and apnea (n = 2). Nine of 19 manifested electroencephalographic seizures. Pathology included chorioamnionitis (n = 7) and fetal thrombotic vasculopathy (n = 5). The latter was associated with focal cerebral infarctions in 3/4 cases. Most cases attributable to perinatal brain injury, except for evolving hypoxic-ischemic encephalopathy, are not identified according to any perinatal characteristics until the onset of signs, limiting opportunities for prevention.
authors.affiliation: Division of Pediatric Neurology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Takenouchi
authors.forename: Ericalyn
authors.initials: E
authors.lastname: Kasdorf
authors.forename: Murray
authors.initials: M
authors.lastname: Engel
authors.forename: Amos
authors.initials: A
authors.lastname: Grunebaum
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Perlman
mesh_terms: D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001720:Birth Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007231:Infant, Newborn; D012307:Risk Factors