Neonatal Neurologic Consultations

Abstract

The pediatric neurologist can serve as a subspecialty consultant for both the fetus and neonate in whom a brain disorder is suspected. Although acute neonatal brain disorders must be assessed and treated vigorously, neurologic disease may occur before the intrapartum period, either from a primary brain disease or secondarily from systemic diseases. Medical conditions during the antepartum and intrapartum periods can predispose the fetus or neonate to express acute brain dysfunction as a neonate, representing both acute and chronic conditions. The pediatric neurologist must, therefore, consider maternal, placental, and fetal diseases on which a neonatal encephalopathy may be superimposed. This review describes four consultations by a neonatal neurointensive care service in which an integrative approach to fetal neurology is applied to neonatal consultations, emphasizing perspectives from other subspecialties concerning maternal-fetal medicine, developmental pathology, neonatology, and other pediatric subspecialties. Future strategies for fetal or neonatal brain resuscitation will need to consider the developmental context in which a suspected brain injury occurred during antepartum, intrapartum, and neonatal periods. Accurate etiologic diagnoses and timing of an insult will influence the forms of therapy of neuroprotection or neurorescue.