DOCUMENTATION OF PRENATAL BRAIN INJURY

Abstract

The timing of brain injury which leads to neurologic handicap in infants is difficult to establish. However, in infants who die it is possible to estimate the duration of injury by neuropathologic assessment of the state of necrosis, gliosis, alteration of extravascular red cells and calcification.We reviewed the neuropathologic findings, birth history, and clinical course of neonates autopsied at our center during 1982. Five of the 6 term infants and 10 of the 25 premature infants who died at less than 7 days of age were shown to have brain lesions which predated their time of delivery. Two of the 5 term infants and 7 of the 10 preterm infants had Apgar scores of <3 at 1 min and <5 at 5 min of age. Fetal distress was usually unrecognized and only 1 term and 3 preterm infants were delivered by C-section. Clinical characteristics observed did not suggest a recognizable syndrome of prenatal brain injury. However, the gut and lungs had also been affected prenatally in several cases. Respiratory failure was the usual cause of death.We conclude that a number of infants dying at less than one week of age have evidence of prenatal brain injury. Birth asphyxia is frequently associated with this finding and this suggests that such infants do not tolerate labor. The probability of prenatal brain injury in surviving neurologically damaged infants with similar birth histories seems high. The medicolegal implications are important and we recommend careful neuropathological evaluation of all such infants who die.