The lack of oxygen (hypoxia) affects vital structures in the brain with consequences, depending on the stage in development at which this occurs, varying from mild to moderate to severe. The most dramatic consequences are the development of cerebral palsy, cognitive defects and seizures.
Work is ongoing in several Departments in the Faculty of Health Sciences involving the following lead researchers and their teams:
Their research foci are three-fold: to establish ways to prevent hypoxia from occurring; to understand the pathophysiological mechanisms that lead to some of the dramatic consequences; and to treat patients who suffer brain injury.
Ideally, babies at risk of developing brain hypoxia should be detected before labour starts. In this regard, the Maternal and Infant Health Care Strategies Research Unit is working with the Council for Scientific and Industrial Research (CSIR) on testing a simple continuous wave Doppler apparatus that measures blood flow in the umbilical cord (Umbiflow). By screening pregnant mothers during pregnancy, foetuses at special risk of dying in utero before labour, and those at risk of developing foetal distress in labour, can be detected.
With regard to pathophysiological mechanisms, the contribution of predisposing genetic factors has been greatly understudied in brain injury resulting from hypoxia. If one is to draw an analogy with cerebral palsy, for which a strong genetic component is beginning to emerge, it is quite possible that we will see that those infants who manifest the consequences of brain hypoxia do so as a result of a genetic predisposition, which may render their central nervous systems more susceptible to this kind of injury.
The treatment of infants who manifest the consequences of brain injury possibly due to hypoxia requires a comprehensive approach, from the early neonatal stage and extends throughout their entire lives. They require not only chronic medical intervention, but education and vocational options also need to be addressed.
Apart from the importance of being able to prevent and treat hypoxic brain injury and of expanding our knowledge base in this area, ongoing work also has important medico-legal implications. There is currently a wave of litigation in the country that involves children who apparently have been subjected to hypoxia and who have, for example, developed cerebral palsy. In light of the dearth of knowledge in this area on the pathogenesis of the disease, a detailed and accurate understanding of the consequences of hypoxia will have implications not only for patients, but also for both the medical and legal professions.
