Neonatology pp 2295-2314 | Cite as

The Timing of Neonatal Brain Damage

  • Serafina PerroneEmail author
  • Giuseppe Buonocore
Reference work entry


Brain injury in newborns is a complex process involving multiple pathways, which may complicate the determination of timing of the injury and the early identification of infants at risk for neonatal encephalopathy. Much of the injury occurs before birth and may be the result of more than a single injury. An abnormal insult applied to a critical point in intrauterine life determines permanent changes in phenotype disrupting the normal fetal development and leading to fetal programming of diseases. Additionally, brain development, including maturation and structure, may render the baby more or less susceptible to perinatal injury. At present there is no universal agreement on objective laboratory biomarkers as a gold standard to support the diagnosis of perinatal asphyxia. Placental findings can serve as markers for processes occurring in the mother or fetus. An expert assessment of the placental pathology can provide temporally and mechanistically specific data not available from any other source. Magnetic resonance imaging (MRI) of the infants with neonatal encephalopathy is very contributive to elucidate the mechanism and timing of asphyxia in conjunction with the clinical examination.

Evidence of multi-organ failure in infants with severe encephalopathy is helpful and used as an additional diagnostic criterion in the recognition of the hypoxic–ischemic insult; however, it is not specific or essential. Several tissue biomarkers suggestive of brain injury in newborns with neonatal encephalopathy have been identified; however, they are not still validated as useful in clinical practice.

In the event of newborn with clinical signs of perinatal hypoxia at birth, it is necessary to have access to a readable cardiotocography, a well-documented partogram, a complete analysis of umbilical cord gases, a placental pathology, and an extensive clinical work-up of the newborn infant including cerebral MRI. Placental histologic examination should be required in order to confirm sudden catastrophic events occurring before or during labor or to detect occult thrombotic processes affecting the fetal circulation, patterns of decreased placental reserve, and adaptive responses to chronic hypoxia.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Molecular and Developmental MedicineUniversity Hospital of SienaSienaItaly
  2. 2.University of SienaSienaItaly

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