The fetus at the tipping point: modifying the outcome of fetal asphyxia

The Journal of Physiology
Simerdeep K DhillonLaura Bennet

Abstract

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.

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Citations

Mar 17, 2020·Acta Physiologica·Alexey S PospelovJuha Voipio
Dec 1, 2018·The Journal of Physiology·L BennetA J Gunn
Jul 30, 2019·Frontiers in Endocrinology·Felipe A BeñaldoMaría Serón-Ferré
Jun 7, 2019·Neural Regeneration Research·Anthony DaviesJoanne O Davidson
May 1, 2020·Italian Journal of Pediatrics·Domenico Umberto De RoseUNKNOWN Study Group of Neonatal Infectious Diseases of The Italian Society of Neonatology (SIN)
Oct 13, 2020·Frontiers in Pediatrics·Aude CastelMartin G Frasch
May 26, 2021·The Journal of Physiology·Simerdeep K DhillonLaura Bennet
Nov 22, 2021·American Journal of Obstetrics and Gynecology·Christopher A LearAlistair J Gunn

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