Abstracto

Brain injury at birth.

David J R Hutchon

Brain injury at birth, most commonly caused by hypoxia and ischaemia lead to encephalopathy shortly after birth. The incidence has not changed in the last 40 years. The outcome in some neonates of permanent long-term brain injury remains a major problem in obstetrical and neonatal medicine. Despite significant changes in practice the incidence of cerebral palsy has not improved. We review the underlying pathology and highlight a possible cause which has been largely ignored until recently. Interfering with the transitional circulation by early cord clamping results in a 50% reduction in cardiac output and will exacerbate any ischaemic injury. For the infant who is already hypoxic, this could be critical. Solutions to a change in labour room practice to avoid this iatrogenic injury are provided.