Insults in Mother’s Womb and During First Month After Birth Can Cause Long-Term Neurological Defects in Children
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 burden.
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.
The current 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 worldwide.
Reference: Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review; Dr. Michael Mwanik et al; The Lancet Online Publication 13 January 2012.