Perinatal brain damage Flashcards
describe cerebral palsy
non-progressive disorder of movement and posture caused by injury to the immature brain
what is birth asphyxia
Interruption in oxygen delivery to the fetus severe enough to produce
- delayed onset of breathing
- bradycardia/asystole and decreased CO
- metabolic acidosis on cord blood analysis
- impaired muscle tone and reflexes
- cardiac arrest
how is birth asphyxia recognised
APGAR score <=5 at 10 minutes with cord gas pH <7.15
Processes that cause brain cell death after re-oxygenation at a macro level
- prolonged hypotension due to poor cardiac output
- prolonged hypoglycaemia
- prolonged epileptic activity
cellular processes that cause brain-cell death after re-oxygenation
- free radical damage
- calcium influx
- excitotoxic amino acids e.g. glutamate, aspartate
- apoptosis
common brain injury in full term infants
Hypoxic-ischaemic encephalopathy
treatment for HIE
Total body cooling by cooling jacket for 72hours at 33.5 degrees C
causes of brain injury in preterm infants
- intraventricular haemorrhage
- periventricular leucomalacia
When does intraventricular haemorrhage occur and what is it
at 24-32 weeks gestation
vascular germinal matrix with fragile blood vessels and fluctuating cerebral blood flow resulting in perforated blood vessels and bleeding
how to reduce the risk of IVH
prenatal maternal steroids
complications of IVH
- post haemorrhagic hydrocephalus
- death
how does post haemorrhagic hydrocephalus injure the immature brain
- pressure
- distortion
- oedema
- free radicals
- inflammation
Management of severe IVH
Ventriculoperitoneal shunt at term
DRIFT- washing out the ventricles to remove neurotoxins
Periventricular leucomalacia
- what is it
- risk factors
- prevention
- white matter damage
- ischaemia and inflammation
- prenatal MgSO4
Benefits of prenatal MgSO4
Neuroprotective effect- 40% reduction in cerebral palsy
