TY - JOUR
T1 - Hypoxia-ischemia is not an antecedent of most preterm brain damage
T2 - the illusion of validity
AU - Gilles, Floyd
AU - Gressens, Pierre
AU - Dammann, Olaf
AU - Leviton, Alan
N1 - © 2017 The Authors. Developmental Medicine and Child Neurology published by Mac Keith Press.
PY - 2018/2
Y1 - 2018/2
N2 - Brain injury in preterm newborn infants is often attributed to hypoxia-ischemia even when neither hypoxia nor ischemia is documented, and many causative speculations are based on the same assumption. We review human and animal study contributions with their strengths and limitations, and conclude that - despite all the work done in human fetal neuropathology and developmental models in animals - the evidence remains unconvincing that hypoxemia, in the fetus or newborn infant, contributes appreciably to any encephalopathy of prematurity. Giving an inappropriate causal name to a disorder potentially limits the options for change, should our understanding of the etiologies advance. The only observationally-based title we think appropriate is 'encephalopathy of prematurity'. Future pathophysiological research should probably include appropriately designed epidemiology studies, highly active developmental processes, infection and other inflammatory stimuli, the immature immune system, long chain fatty acids and their transporters, and growth (neurotrophic) factors.
AB - Brain injury in preterm newborn infants is often attributed to hypoxia-ischemia even when neither hypoxia nor ischemia is documented, and many causative speculations are based on the same assumption. We review human and animal study contributions with their strengths and limitations, and conclude that - despite all the work done in human fetal neuropathology and developmental models in animals - the evidence remains unconvincing that hypoxemia, in the fetus or newborn infant, contributes appreciably to any encephalopathy of prematurity. Giving an inappropriate causal name to a disorder potentially limits the options for change, should our understanding of the etiologies advance. The only observationally-based title we think appropriate is 'encephalopathy of prematurity'. Future pathophysiological research should probably include appropriately designed epidemiology studies, highly active developmental processes, infection and other inflammatory stimuli, the immature immune system, long chain fatty acids and their transporters, and growth (neurotrophic) factors.
U2 - 10.1111/dmcn.13483
DO - 10.1111/dmcn.13483
M3 - Article
C2 - 28656697
SN - 0012-1622
SP - 120
EP - 125
JO - Developmental Medicine and Child Neurology
JF - Developmental Medicine and Child Neurology
ER -