Developmental Neurology of the Fetus and Newborn

Abstract

There is no doubt that obstetrical dilemmas can lead to damage to the fetal and neonatal brain. Why damage occurs in some cases but not in others in apparently comparable situations of hazard is something we do not yet understand. All we know is that statistical relationships can be demonstrated between certain obstetrical complications and neurological outcome. At its earliest, neurological assessment is carried out in the neonatal period. However, it is often delayed until weeks, months, or years later. Many factors can intervene with the passage of time to distort the relationship between the original insult and neurological function at a later age. The relationships found will of necessity be rather loose and will generally only emerge if large groups are studied. Another problem ensuing from taking the results of late evaluations to monitor outcome is the unacceptably long delay this implies for the obstetrician interested in evaluating his management regimes. Since obstetrical and neonatal care practices change rapidly, long-term neurological results are often only of historical interest.