Outcome after intrapartum hypoxic ischaemia at term

Area of Science:

• Neurology
• Pediatrics
• Neonatology

Background:

• Perinatal hypoxic-ischaemia is a significant cause of childhood disability.
• Understanding the specific disabilities linked to this condition is crucial for diagnosis and management.

Purpose of the Study:

• To review the evidence linking perinatal hypoxic-ischaemia at term to various childhood disabilities.
• To clarify the specific types of cerebral palsy (CP) associated with hypoxic-ischaemic insults.

Main Methods:

• Systematic review of existing literature.
• Analysis of evidence strength for causal links between hypoxic-ischaemia and specific disabilities.

Main Results:

• Strongest evidence links profound hypoxic-ischaemia to dyskinetic tetraplegic cerebral palsy.
• Hemiplegic CP is often caused by stroke, not term hypoxic-ischaemia.
• Diplegic CP is associated with prematurity and periventricular leukomalacia; ataxic CP is unlikely due to asphyxia.
• Survivors of perinatal hypoxic-ischaemia are at risk for cognitive deficits, even without motor disorders.

Conclusions:

• The specific type of cerebral palsy depends on the nature and timing of the insult.
• Cognitive deficits are a significant risk following perinatal hypoxic-ischaemia.
• Attention deficit hyperactivity disorder and autism are not caused by hypoxic-ischaemia.
• Neuroprotective therapies like cooling may reduce the prevalence of CP.