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Does hypoxemia prevent brain damage in birth asphyxia?

D E Ballot1, A D Rothberg, V A Davies

  • 1Department of Paediatrics and Child Health, Johannesburg Hospital, University of the Witwatersrand, South Africa.

Medical Hypotheses
|October 1, 1993
PubMed
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Hypoxic ischemic encephalopathy (HIE) in newborns may be reduced by persistent pulmonary hypertension of the neonate (PPHN). PPHN-related hypoxemia might protect against HIE by limiting free radical production.

Area of Science:

  • Neonatal Medicine
  • Perinatal Biology
  • Neuroscience

Background:

  • Hypoxic ischemic encephalopathy (HIE) is linked to birth asphyxia and reperfusion injury.
  • Oxygen-free radicals are implicated in HIE pathogenesis.
  • Resuscitation with high oxygen concentrations may worsen HIE via hyperoxia.

Purpose of the Study:

  • To investigate the protective role of sustained hypoxemia in birth-asphyxiated infants.
  • To examine the relationship between HIE and persistent pulmonary hypertension of the neonate (PPHN).

Main Methods:

  • Retrospective analysis of 39 asphyxiated neonates.
  • Assessed incidence of HIE and PPHN.
  • Compared neonates with HIE, PPHN, and both conditions.

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Main Results:

  • 28 neonates had HIE, 10 had PPHN.
  • Only 1 neonate had both HIE and PPHN.
  • A significant inverse relationship was observed between HIE and PPHN.

Conclusions:

  • Persistent pulmonary hypertension of the neonate (PPHN)-associated hypoxemia may protect against hypoxic ischemic encephalopathy (HIE).
  • Hypoxemia might limit oxygen-derived free radical production, mitigating HIE.
  • Findings support research into air versus oxygen resuscitation strategies for birth asphyxia.