V. Popescu *, Magdalena Efrim *, Mihaela Răduţ-Ştefănescu *, Elena Bălănescu *, Alice Antrasian *
* Prof. Dr. Valeriu Popescu, dr. Magdalena Efrim, dr. Mihaela Răduţ-Stefănescu, dr. Elena Bălănescu, dr. Alice Antrasian – Spitalul Clinic de copii “Dr. V. Gomoiu” București
Abstract
Neurologic pathology determined by hypoxic-ischemia in newborn is one of the major problems in neonatal intensive care units. Although the effects of hypoxia and ischemia on the fetus are pansystemic, the clinical course is determined by the impact of hypoxia-ischemia on the newborn’s brain, that results in hypoxic-ischemic encephalopathy, that obviously is one of the most frequent neurological disorder in the neonatal period. The physiopathology of hypoxic-ischemic brain damage is presented by the means of five well-known neuropathological patterns: selective neuronal necrosis; status marmoratus of basal ganglia and thalamus; parasagital lesions; periventricular leukomalacia; focal and multifocal ischemic cerebral necrosis. Often these lesions coexist, although one of them is predominant, depending on the type of injury and gestational age. Present therapies to prevent, or treat perinatal brain damage are ineffective. Hypoxic-ischemic encephalopathy is the most important, unsolved, neglected problem in neonatology. Until now, in the field of neuroprotection there have not been many promising new therapies available. Unfortunately, new therapies for hypoxic-ischemic encephalopathy currently under intense investigation, especially in experimental animals – inhibitors of oxygenfree radical generation and free-radicals scavengers, antagonists of excitatory amino acids, calcium channel b,ockers and nitric oxyde synthase inhibitors, among others – are irrelevant, being of limited ctinical benefit and of no predictive value. This is the time to try to set up a system that would facilitate cooperation between basic neuroscientists, obstreticians, neonatologists, National Institute of Child Health and Human Development, National Institute of Neurological Disorders and Stroke, foundations, the Food and Drud Administrations, neonatal networks and industry. The model system could be similar to the National Cancer Institute’s Pediatric Oncology Group. The goal is the elimination of perinatal brain damage.