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dc.contributor.authorBecher, Julie-Clareen
dc.date.accessioned2018-03-29T12:16:38Z
dc.date.available2018-03-29T12:16:38Z
dc.date.issued2006
dc.identifier.urihttp://hdl.handle.net/1842/29120
dc.description.abstracten
dc.description.abstractINTRODUCTION Despite improved intrapartum monitoring of the fetus, the rate of cerebral palsy has not decreased. Many studies now suggest that the majority of children with such disability may sustain damage in utero. Current understanding and identification of antenatal brain injury is poor and individual vulnerability may be important. Specific genotypes such as Apolipoprotein E are disadvantageous to outcome in the context of adult brain injury and may also be important in early development.en
dc.description.abstractOBJECTIVES An aim of this project was to identify clinical and genetic risk factors for early neonatal mortality within the Scottish population with special consideration for those infants born in an asphyxiated condition. A further aim was to determine the prevalence of antenatal brain injury within this population and to correlate neuropathology with clinical factors.en
dc.description.abstractMETHODS Clinical data and neuropathological specimens were collected as part of the Scottish National Perinatal Neuropathology Study from all 22 delivery units throughout Scotland. Birth asphyxia was defined and infants were classified accordingly. Neuropathological examination was performed by a single observer in Edinburgh who was blind to clinical detail. Apolipoprotein E genotype was analysed and compared with known published data for adults and healthy newborns. Comparisons of categorical data were made with the Chi-square test and numerical data were compared using the unpaired student's t-test or the Mann Whitney U test.en
dc.description.abstractRESULTS Clinical data was collected from 191 early neonatal deaths. Complications of pregnancy were common in all neonatal deaths. The only predictive factors for asphyxia were indicators of intrapartum fetal distress. Neuropathological examination was possible in 59 infants surviving 3 days or less. Evidence of prelabour brain injury was observed in nearly half of this cohort, and this was significantly more common in asphyxiated infants and those who developed an encephalopathy. The only clinical associations of such damage were the presence of cardiotocograph abnormalities, meconium staining and severe depression at birth. Apolipoprotein E analysis was performed in 252 perinatal deaths. There was an over representation of the s4 allele among healthy newborns compared to perinatal deaths and adults.en
dc.description.abstractCONCLUSIONS Brain injury occurring in utero is a common finding among neonatal deaths, particularly in those born with asphyxia. Current intrapartum indicators of fetal distress may signify a fetus who has already suffered compromise prior to the onset of labour. Differences in the Apolipoprotein s4 genotype in perinatal populations suggest that the fetus may vary in its ability to withstand fatal injury.en
dc.publisherThe University of Edinburghen
dc.relation.ispartofAnnexe Thesis Digitisation Project 2018 Block 17en
dc.relation.isreferencedbyAlready catalogueden
dc.titleEpidemiological and pathological correlates of early neonatal mortalityen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameMD Doctor of Medicineen


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