Prematurity or Infection Likely Cause of Neonate Brain Damage

In a new study, researchers have found that the most likely causes of brain damage among low birth-weight neonates are prematurity and infections, not oxygen starvation, as previously thought. The findings were reported in the June 2003 issue of Obstetrics and Gynecology.

The study involved 213 babies weighing less then three pounds and five ounces who were born at Johns Hopkins Medical Center (Baltimore, MD, USA) and admitted to the hospitals' neonatal intensive care unit.

The researchers reviewed all maternal and neonatal records, checking gestational age at delivery, mode of delivery, birth weights, Apgar scores, and infection status. The smaller the infants were at birth and the less time they spent in the womb, the more likely they were to have some form of brain damage. Neonates born with infections were more likely to have brain complications than those born without infections. There were seven deaths among the newborns, in six infants with brain damage and one baby without.

Among the infants studied, 77 (36%) had some type of neurologic problem. Of these, 61 had bleeding, eight had seizures, 13 had hydrocephalus, and nine had periventricular leukomalacia (brain softening). Several infants were found to have several complications. An important finding was that only three of the 52 whose umbilical cord gases were measured had evidence of acidity, which argues against the birthing process itself as the cause of the neurologic problems.

"In our study, oxygen deficiency played a very small role in the neurologic injuries seen in these infants,” said lead author Cynthia J. Holcroft, M.D., instructor of gynecology and obstetrics at Johns Hopkins. "Even with the increase in the Cesarian rate from 5% to almost 25% and the widespread introduction of electronic fetal heart rate monitoring, the incidence of cerebral palsy and other problems has remained unchanged over the past 40 years.”




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