Intrauterine and neonatal insults have long-term
consequences on the neurodevelopment, suggests study.
Timely antenatal care and strengthened newborn care facilities can bring
down the incidence of long term sequelae of intrauterine and neonatal insults.
Findings of a new study
urge the global community to harness a better outcome from primary and
secondary health care facilities to diminish these insults.
Many neonates survive
major insults, such as infections and birth complications with no evidence of
impairments. This owes to the plasticity of the developing brain and the
availability of good medical care. However, some newborns suffer impairment
of the growth and development of the brain or central nervous system as a
consequence of these insults.
About 140 million births occur per year worldwide; 2·6 million are
still-born. Of the 3.6 million neonatal deaths that occur, more
than 90% happen in the resource-poor countries. Rural areas carry the heaviest burden of deaths that occur within the
first 28 days of life.
Neonatal deaths have
rung danger alarms globally, they account for more than 40% of mortality in
children younger than 5 years.
Factors like infections
( due to notably sepsis, meningitis, and neonatal tetanus) and hypoxia causing
brain damage can occur during childbirth or during delivery and are common
causes for neonatal deaths. In hypoxia causing brain damage (ischaemic
encephalopathy), the brain is deprived of adequate oxygen supply. Preterm birth
complications, jaundice and congenital infections with cytomegalovirus,
toxoplasma, syphilis, and rubella are other key players that add up to the
Many neonates survive
the major insults, thanks to the magnificent versatile creation called human
brain. The plasticity of the brain and the improved modern medical care
actually hide the real problem. The various insults suffered during foetal life
inside the mother's womb and the ones inflicted during the neonatal period
cause significant negative impacts in the long run. The proper development of
the brain and the central nervous system are affected. The degree of damage may
vary. Multiple domains such as the power of perception, learning and reasoning
are affected along with motor impairment, hearing and vision loss.
Worldwide newborn survival earned attention only
very recently, and significant efforts have been directed at the prevention of
deaths.We need to work harder at the levels of primary and secondary prevention.
This would reduce the burden on families, and societies impacted by
neurodevelopmental impairments. The issue of shortened
life expectancy also gets addressed by suitable interventions.
Timely and highly
cost-effective interventions can prevent intrapartum complications, neonatal
tetanus, and neonatal jaundice. Ensuring the availability of antenatal steroid
drugs in low-income and middle-income countries will bring down the
complications of preterm birth. Effective newborn care, timely and appropriate
use of oxygen, may reduce the severity of negative sequelae. Better
rehabilitation and supportive care may ensure improved quality of life.
interpretations are based on expert review of published data. Authors of the
article published in the Lancet
recommend a more cohesive, interagency, proactive approach to
improving data. It's high time to call for changes to policy and programmes
Long-term neurodevelopmental outcomes after intrauterine and neonatal
insults: a systematic review; Dr. Michael Mwanik et al; The Lancet Online
Publication 13 January 2012.