Perinatal Events and Brain Damage in Surviving Children: Based on Papers Presented at an International Conference Held in Heidelberg in 1986

This book aims to give an objective and up-to-date evaluation of the known relationships between perinatal events occuring during pregnancy, labor and the neonatal period on the one hand, and the occurrence of brain damage in surviving children on the other. The various aspects of the subject are covered in sections on pathophysiology, epidemiology, effect of chronic intrauterine deprivation and chronic hypoxia, effect of intrapartum acute hypoxia and trauma, prematurity and the problems of neonatal intensive care. This review offers the most comprehensive and current assessment available of the connections between perinatal events and later brain damage with special consideration given to the information derived during the perinatal period by modern diagnostic procedures. The book will help clarify uncertainties regarding the etiology of brain damage, especially cerebral palsy, and will be of great value to the practicing obstetrician and neonatologist in his daily decision-making.

Decision making in modem obstetrics and perinatology is con- trolled by a variety of different factors, but there is little doubt that in industrialized countries one of the most powerful single factors is the concern and fear of causing permanent brain damage in the unborn and newborn. The dramatic increase in the rates of abdom- inal deliveries in many parts of the world is certainly rooted to a substantial part in the bstetrician's concern not so much about possible perinatal death, but more so about permanent brain dam- age in surviving children. This trend has been accelerated by the increasing number of litigations in connection with brain damage observed in many societies. This problem itself has many aspects, but it seems evident that litigation - justified or unjustified - is one modem expression of the human and social tragedy inflicted on individuals and families by the birth of a brain-damaged child. The medical, social, and human importance of the problem is in sharp contrast to the relative lack of scientific knowledge avail- able. This became very clear when the National Institutes of Health published the excellent review in 1985 on "Prenatal and Perinatal Factors Associated with Brain Disorders" and its editor, J. M.

Contents: Epidemiology.- Biology and Pathogenetic Mechanisms.- Intrauterine Deprivation - Growth Retardation and Chronic Hypoxia.- Intrapartum Asphyxia and Birth Trauma.- Intracranial Hemorrhage and Ischemia.- Prognosis of the Very Low Birthweight and Very Preterm Infant.- Recent Follow-up Studies.- Appendix.