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The fetus at the tipping point: modifying the outcome of fetal asphyxia
Author(s) -
Dhillon Simerdeep K.,
Lear Christopher A.,
Galinsky Robert,
Wassink Guido,
Davidson Joanne O.,
Juul Sandra,
Robertson Nicola J.,
Gunn Alistair J.,
Bennet Laura
Publication year - 2018
Publication title -
the journal of physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.802
H-Index - 240
eISSN - 1469-7793
pISSN - 0022-3751
DOI - 10.1113/jp274949
Subject(s) - medicine , asphyxia , hypoxia (environmental) , fetus , cerebral palsy , ischemia , perinatal asphyxia , pregnancy , low birth weight , anesthesia , obstetrics , physiology , physical therapy , chemistry , organic chemistry , biology , oxygen , genetics
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.