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Perinatal performance, crucial for cognitive development

Perinatal performance, crucial for cognitive development

Despite the important genetic influence, some perinatal pediatric interventions can determine the survival and subsequent Cognitive Development of the newborn. The options in addressing these key moments have put an end to the Xxxii Annual Meeting of the SENP .

The management of certain perinatal circumstances is crucial for the subsequent cognitive and motor development of the newborn , but generates controversies in the decision-making at key moments.This aspect has not been forgotten in the XXXII Annual Meeting of the Spanish Society of Pediatric Neurology (SENP), which has exposed various hypotheses to address situations such as delayed intrauterine growth (CIR), extreme prematurity or epilepsies neonatal .The situation of a newborn less than 26 weeks gestation is usually not easy in the first days of life. The survival depends largely on the pediatric intensive management and aggressiveness of treatment performed with the aim that the neonate succeed. In this regard, Malcolm Levene, professor of Pediatrics at the Hospital of Leeds, in the United Kingdom, reviewed in Alicante the EPIcure study, a meta-analysis carried out in Ireland on the cognitive evolution of premature children, between 22 and 26 weeks of gestation, born in 1995 and followed up after ten years.

The conference, held in Alicante, has had different opinions in all the above-mentioned areas, in which any false step can have permanent consequences on the intellectual development of the child.

“The objective was to know to what extent neonatal intensive care was justified in a fetus of extreme prematurity and the future consequences in the cognitive-motor development of the child”, clarified Levene. The conclusions showed that the increase in survival in cases of 23 weeks gestation or less was possible at the cost of a parallel increase in the number of cases with significant deficiencies in neurodevelopment .

“This fact raises a controversial ethical debate about intensive care in neonates for 22-23 weeks, each doctor must decide at the expense of studying the risks and benefits of increasing the survival rate.”

Finally, one of the presentations with which the meeting concluded was the intervention of Shaul Harel, from the University of Tel-Aviv, in Israel, who recalled the consequences of CIR in neurodevelopment. “While there are major deficiencies, the lack of coordination and clumsiness of movements appear in a high proportion of cases, ” he said. Once again, methods of detection and early treatment would place the most appropriate therapeutic line in each case in the hands of the neuropaediatrician.

Option against epilepsy

The repercussion of the neonatal epilepsies and their pharmacological treatment have been two recurrent aspects in the days. After years of controversy, specialists like José Luis Herranz, who has developed the Epilepsy Unit at the Marquis de Valdecilla Hospital in Santander, have obtained valid conclusions.

“The data support that both the number of seizures and the pharmacology administered in their treatment influence cognitive development.The therapeutic arsenal available allows us to treat with drugs such as valproate, carbamazepine and other new generation antiepileptic drugs, and thus avoid barbiturates and benzodiazepines, with a strong neurological impact “.

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Perinatal performance, crucial for cognitive development


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