Aggiornamento
L’asfissia nel neonato a termine
Perinatal asphyxia in fullterm infants: do general movements
Elena Coccolini1, Rossella Frassoldati1, Marina Palmieri2, Alessandra Todeschini3, Luca Ori2, Chiara Peppoloni2, Carolina Bariola2, Isotta Guidotti2, Licia Lugli2, Fabrizio Ferrari2
1Scuola di Specializzazione in Pediatria; 2Dipartimento ad Attività Integrata Materno-Infantile, Struttura Complessa di Neonatologia; 3Unità Operativa Complessa di Neuroradiologia, Università di Modena e Reggio Emilia
Gennaio 2014 - pagg. 26 -32
Abstract
Notwithstanding progress in perinatal-neonatal medicine, perinatal asphyxia has not disappeared.
Nowadays, it can be observed in 0.5-2‰ of term-born infants; it is associated
with a high rate of mortality and a wide range of disabilities. The link among perinatal
asphyxia, hypoxic ischemic encephalopathy (HIE) and neuromotor outcome is complex.
In the recent years, progress in cerebral magnetic resonance imaging (MRI) and in the spontaneous
movement of the newborn led to a better comprehension of the pathogenesis and
evolution of this event. Three major novelties were recently defined: first, the possibility of
neuroprotection through hypothermia; second, the definition of the structure and the function
of the brain through different MRI techniques; third, general movements (GMs) as an
early marker of cerebral injury and predictors of later cerebral palsy (CP). Term-born infants
present 2 typical patterns of cerebral injury: the most common affects basal ganglia and
thalami (BGT), sometimes with cortical and white matter (WM) involvement; the other is limited
to WM with or without cortical injury. The outcome depends on the extension, site and
severity of the damage. Lesions other than these should cast doubt on the diagnosis of perinatal
asphyxia, MRI in the neonatal period is therefore of relevance for medico-legal purposes.
As for the prognosis, it is important to evaluate the severity of the HIE according to
the three stages of Sarnat, the severity of abnormal electroencephalogram and the type of
GMs abnormalities. MRI and sequential observation of GMs (abnormal developmental
trajectories) are complementary tools for predicting motor outcome and for selecting infants
who require early rehabilitation.
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Corrispondenza: fabrizio.ferrari@unimore.it