J Physiol 596.23 (2018) pp 5571–5592 5571
TOPICAL REVIEW The fetus at the tipping point: modifying the outcome of fetal asphyxia
Simerdeep K. Dhillon1,ChristopherA.Lear1 , Robert Galinsky1,2 , Guido Wassink1 , Joanne O. Davidson1 , Sandra Juul3,NicolaJ.Robertson4,AlistairJ.Gunn1 and Laura Bennet1
1The Department of Physiology, University of Auckland, Auckland, New Zealand 2The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia 3Department of Pediatrics, University of Washington, Seattle, WA, USA 4Institute for Women’s Health, University College London, London, UK
Edited by: Ole Petersen and Dino Giussani
Factors that alter perinatal adaptations to hypoxic-ischaemic challenges
• Endogenous neuroprotective factors: neuroinhibitors • Inflammation and hypoxia – dose, timing - Sensitisation trophic and anti-inflammatory factors • Glucocorticoids – dose, timing • Inflammation and hypoxia – dose, timing - Tolerance • Hyperglycaemia - diabetes • Glucocorticoids – species, maturation? • Maternal health/lifestyle – alcohol, smoking, drugs, • Magnesium sulphate – dose and timing? obesity, stress • Maternal health/lifestyle – diet, exercise • Prematurity, sex, parity • Sex, parity
More brain injury
Less brain injury
HI
Exogenous treatments for HIE: Current: Therapeutic hypothermia for term newborns Current potential new therapies: Melatonin, Erythropoietin, Stem cells, Allopurinol, Magnesium sulphate, Xenon The Journal of Physiology
Abstract Brain injury around birth is associated with nearly half of all cases of cerebral palsy. Although brain injury is multifactorial, particularly after preterm birth, acute hypoxia–ischaemia is a major contributor to injury. It is now well established that the severity of injury after
Simerdeep Dhillon is a PhD student working with Professor Laura Bennet to understand the role of endogenous growth factors such as erythropoietin in the brain and how best to use them to help improve neural recovery from perinatal hypoxia. Laura Bennet is a fetal systems physiologist whose foundation studies on preterm brain injury has led to new understanding of how the fetus adapts to key challenges such as oxygen lack, infection and common maternal therapies. She is building on this work to develop new treatments to protect and potentially rebuild the brain.