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Anoxic brain injury is a condition where there is an absence of oxygen to an organ's tissues although there is adequate blood flow to the tissue. Hypoxia is a condition in which there is a decrease of oxygen to the tissue in spite of adequate blood flow to the tissue. Anoxia and hypoxia are often used interchangeably--without regard to their specific meanings--to describe a condition that occurs in an organ when there is a diminished supply of oxygen to the organ's tissues.
The American Psychological Association (APA) reports on links among pre-term birth, risk for birth hypoxia, and cognitive problems,
Birth is a time of risk for the human brain, especially in pre-term infants. For vulnerable premature babies, biochemical signs of reduced blood oxygen levels or hypoxia soon after birth are associated with lower intelligence and language skills. Premature deliveries are on the rise due to more multiple pregnancies, induced labor, and older mothers.
Anoxia and hypoxia may be caused by strangulation, anesthetic accidents, or poisoning. In severe cases of anoxia and hypoxia, the patient is often comatose or unconscious for periods ranging from hours to days, weeks, or months. Seizures, muscle spasms, and neck stiffness may occur.
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A study proved there is a significant relationship between blood pH soon after birth and later cognitive and language skills. For example, the pre-term group, with mild to moderate acidosis, scored about 10 to 11 points lower on verbal and visual-spatial tests than the low-risk pre-term group. Such data reveals that even a minor risk for hypoxia around birth may have a discernible influence on the course of cognitive development.
Even minor risk of oxygen deprivation at or immediately after birth may place premature babies at greater risk for cognitive and language problems, proportionate to the degree of hypoxia.
What could be done to prevent birth hypoxia?
Loss of oxygen to the brain may result in death or a lifetime of blindness, mental retardation, or cerebral palsy. Research shows that lowering a newborn's body temperature a few degrees could reduce the likelihood of death or disability associated with depleted oxygen.
Complications of Oxygen Deprivation at Birth
Oxygen deprivation or hypoxia, typically occurs as a complication of birth. For example, if the umbilical cord becomes trapped between a baby's head and the wall of the uterus, pressure on the cord may cut off the baby's oxygen supply. Hypoxia may also result from blood loss, perhaps when the placenta tears free of the uterine wall or the uterus ruptures. Blood loss or hypoxia at birth may lead to hypoxic ischemic encephalopathy (HIE), a condition experienced by 1 in every 1,000 newborns.
When an infant has received inadequate supply of oxygen during labor or delivery, it may cause brain injury, confirmed by less electrical activity in the brain or brain wave analysis. A lack of oxygen at birth can result from a ruptured uterus, placenta which receives oxygen, nutrients, antibodies and hormones from the mother's blood and passes out the waste. The umbilical cord can wrap around the infant's neck and cut of the supply of oxygen or suffer hypoxic damage. Infants that survive can have long lasting disabling complications, such as cerebral palsy where a child has trouble controlling the muscles of the body, and may not be able to walk, talk, eat, or play. Hearing and speech problems may require the child to receive treatment by a speech therapist. Previously, no treatment or therapy was available to reverse this damage or prevent this damage from occurring, except only to place the infant on a respirator and give medicine to support blood pressure and other functions.
Perinatal asphyxia is the medical condition resulting from deprivation of oxygen to a newborn infant long enough to cause apparent harm. It results most commonly from a drop in maternal blood pressure or interference during delivery with blood flow to the infant's brain. This can occur due to inadequate circulation, impaired respiratory effort, or inadequate ventilation.
Perinatal asphyxia happens in 2 to 10 per 1,000 newborns that are born prematurely.
An infant suffering severe perinatal asphyxia usually has poor color and lack of responsiveness, muscle tone, and respiratory effort. Extreme degrees of asphyxia can cause cardiac arrest and death. If resuscitation is successful, the infant is usually transferred to a neonatal ICU.
Hypoxic damage can occur to most of the infant's organs but brain damage is of most concern and perhaps the least likely to quickly and completely heal. In severe cases, an infant may survive, but with damage to the brain manifested in development.
What is Hypoxic ischemic encephalopathy? (HIE)
In spite of major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or hypoxic-ischemic encephalopathy (HIE), remains a serious condition, causing significant mortality and long-term morbidity.
HIE is characterized by clinical and laboratory evidence of acute or sub-acute brain injury due to asphyxia. Most often, the underlying cause remains unknown. The exact time of brain injury often remains uncertain, and an abnormal brain might be an underlying risk factor.
In the United States and in most technologically advanced countries, the incidence of severe HIE is between 2 to 4 cases per 1,000 births.
Among the infants who survive severe HIE, problems include mental retardation, epilepsy, and cerebral palsy of varying degrees. The latter can be in the form of paraplegia or quadriplegia. Such infants need careful evaluation and support. They may need to be referred to specialized clinics capable of providing coordinated comprehensive follow-up care.
The incidence of long-term complications depends on the severity of HIE. Up to 80% of infants who survive severe HIE develop serious complications, 10-20% develop moderately serious disabilities, and up to 10% are normal. Among the infants who survive moderately severe HIE, 30-50% may suffer from serious long-term complications, and 10-20% with minor neurological morbidities. Infants with mild HIE tend to be free from serious complications.
Whole body hypothermia treatment: Whole-body hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic?ischemic encephalopathy. In a randomized trial, neonates with moderate or severe hypoxic?ischemic encephalopathy randomly assigned to whole-body hypothermia had a significantly reduced risk of death or moderate or severe disability at 18 to 22 months of age. This study suggests that whole-body hypothermia may improve substantially the outcomes for infants with hypoxic?ischemic encephalopathy.
Modest reduction in brain temperature is a promising therapy to reduce brain damage after neonatal encephalopathy as a result of acute perinatal asphyxia. The efficacy of modest hypothermia may in part be dependent on the stability of the desired brain temperature. The objective of this study was to evaluate in newborn animals a commercially available cooling system to control brain temperature during whole-body hypothermia and to use the results of the animal experiments to perform a pilot study evaluating the feasibility of whole-body hypothermia as a neuroprotective therapy for newborns with encephalopathy at birth.
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