Perinatal Events and Brain Damage in Surviving Children by M. Susser, Z. Stein (auth.), Prof. Dr. med. Fred Kubli, Dr.

By M. Susser, Z. Stein (auth.), Prof. Dr. med. Fred Kubli, Dr. Naren Patel, Prof. Dr. med. W. Schmidt, Prof. Dr. med. O. Linderkamp (eds.)

Decision making in modem obstetrics and perinatology is con­ trolled via quite a few various factors, yet there's no doubt that during industrialized nations the most strong unmarried components is the fear and worry of inflicting everlasting mind harm within the unborn and baby. The dramatic bring up within the charges of abdom­ inal deliveries in lots of components of the realm is unquestionably rooted to a considerable half within the ~bstetrician's quandary now not quite a bit approximately attainable perinatal loss of life, yet extra so approximately everlasting mind dam­ age in surviving young children. This development has been speeded up by means of the expanding variety of litigations in reference to mind harm saw in lots of societies. This challenge itself has many elements, however it turns out glaring that litigation - justified or unjustified - is one modem expression of the human and social tragedy inflicted on participants and households via the delivery of a brain-damaged baby. The clinical, social, and human value of the matter is in sharp distinction to the relative loss of medical wisdom avail­ capable. This grew to become very transparent whilst the nationwide Institutes of well-being released the superb overview in 1985 on "Prenatal and Perinatal elements linked to mind problems" and its editor, J. M.

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Improved Capacity for Case Identification. This is not likely because of the way the study was organized. The same investigators examined all children and doubtful diagnoses were controlled. The same criteria for inclusion of cases were used throughout the periods. Special emphasis was laid on not changing the cut-off point in borderline cases. Improved Survival Mter Severe Brain Damage Due to Intrauterine Asphyxia, Perinatal Brain Ischemia or Hemorrhage, or Other Causes. This potential explanation raises many more complicated problems.

This potential explanation raises many more complicated problems. The early neonatal mortality rate (0-7 days) decreased remarkably over the period with an increasing CP rate. 4 per 1000 in 1981. The improvement was uniform at all gestational ages. This 50 , ... ' .. 70 • • t 75-78 + 1981 > 2500 9 Fig. 3. Course of birthweightspecific prevalence rates of CP per 1000 infants surviving the 1 week of life in western Sweden 1963-1978. Numerical data on the rise in the group above 2500 g is given in the text.

More than half of the MMR cases and almost 20% of SMR cases lacked traces that would refer them to one of the etiologic groups shown. In a considerable number of cases, a familial disposition was suspected in MMR, as at least one other family member showed a subnormal school performance. Epidemiologic Panorama of Brain Impairments and Causative Factors 35 Table 7. Origin of mental retardation in Gothenburg, Sweden, according to Hagberg et aI. (1981 b) Cause Prenatal Genetic Syndromes acquired Alcohol Infection Perinatal" Postnatal Psychosis Not traceable Familial NonfamiIiaI SMR MMR (%) (%) 34 12 5 10 8 o 7 15 o 11 1 18 2 2 4 14 29 26 • Period from 28 weeks of gestation to 28th postnatal day In summary, these series demonstrate that, regardless of the severity of mental retardation, about 15%-20% might have an origin due to identifiable factors operating from the 28th week of gestation until the end of the neonatal period.

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