Birth Asphyxia and the Brain: Basic Science and Clinical Implications

This book is an excellent summary of contemporary knowledge of the clinical pathogenesis and manifestations of hypoxic-ischemic encephalopathy and birth asphyxia. This text presents a state-of-the-art review of asphyxial brain injury to the fetus and new born, a leading source of both neonatal mortality and long-term neurologic disability. Beginning with an historical overview of birth-related injury, followed by an epidemiologic review of the relationship of birth injury to later neuromotor disability, it provides a detailed analysis and exhaustive review of each aspect. The contributors are among the most knowledgeable international authorities in the field; they have synthesized a uniformity of medical and scientific quality, clarity of style, and thoroughness of scope. Continual emphasis is placed on the material's relevance and usefulness to clinicians; equally important is the emphasis on communication between clinicians and basic neuroscientists. The book's first section provides an overview of the history and epidemiology of birth-related brain injury and its relationship to later neuromotor disability. The next section examines mechanisms of injury from a cellular and molecular perspective, including: and examination of the neurotoxic cascade; cytokine-mediated brain damage; the roles of glucose and acidsosis on neuronal injury; cerebral energy depletion; apoptosis and necrosis; the roles of neuronal and vascular nitric oxide; and free radical-mediated processes. The following section deals with clinical birth asphyxia, and includes chapters on prenatal injury, intrapartum injury, clinical management, neuroimaging, and hypothermia as a potential intervention. The last section discusses the medico-legal aspects of asphyxial brain injury. Throughout the various chapters, the authors have preserved the important context of normal development, with an emphasis on the need for fundamental pathogenetic data, to allow for rational approaches to prevention and treatment. The task of paediatricians and neonatologists in coming years will be to better understand the mechanism of brain damage, the prediction of disability, and the introduction of efficacious neuroprotective strategies. To that end, this volume deserves wide recognition by physicians in all disciplines related to neonatal care, including paediatricians, neonatologists, neurologists, obstetricians, family practitioners, nurses and legal counsel.