Scher M S
Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106-1736, USA.
Semin Pediatr Neurol. 2001 Jun;8(2):55-73. doi: 10.1053/spen.2001.24837.
Pediatric neurologists provide an important consultative role for the fetus or neonate with a suspected brain disorder. Although most consultations are initiated after birth, neonatal neurologic dysfunction may be reflective of fetal brain damage or maldevelopment. Maternal or placental/cord disease states can predispose the fetus or neonate to brain disorders during the antepartum, intrapartum, or early postpartum periods. Neurologists must therefore consider maternal, placental, and fetal conditions on which a neonatal encephalopathy may be superimposed, with or without recent brain injury. This review suggests how the pediatric neurologist can contribute more effectively to fetal and neonatal neurologic evaluations regarding etiologies and mechanisms of brain injury; their role will enhance diagnostic services composed of maternal-fetal specialists, placental and pediatric pathologists, neonatologists, neurosurgeons, geneticists, and other pediatric subspecialists. Selected examples of structural markers during fetal life, and functional markers during neonatal life, illustrate the wide spectrum of disease states that are highly dependent on the timing and location of brain injury. The pediatric neurologist has the opportunity to integrate these complementary lines of investigation into a responsive consultative opinion, which is both medically accurate and ethical, responsible to the welfare of the mother and child.
儿科神经科医生在为疑似患有脑部疾病的胎儿或新生儿提供咨询方面发挥着重要作用。尽管大多数咨询是在出生后开始的，但新生儿神经功能障碍可能反映胎儿脑损伤或发育异常。母亲或胎盘/脐带疾病状态可使胎儿或新生儿在产前、产时或产后早期易患脑部疾病。因此，神经科医生必须考虑可能叠加新生儿脑病的母亲、胎盘和胎儿状况，无论近期有无脑损伤。本综述提出了儿科神经科医生如何能更有效地为胎儿和新生儿神经评估在脑损伤的病因和机制方面做出贡献；他们的作用将加强由母胎专家、胎盘和儿科病理学家、新生儿科医生、神经外科医生、遗传学家和其他儿科亚专科医生组成的诊断服务。胎儿期的结构标志物和新生儿期的功能标志物的选定示例说明了高度依赖于脑损伤时间和部位的广泛疾病状态。儿科神经科医生有机会将这些互补的调查线索整合到一个及时的咨询意见中，该意见在医学上准确且符合伦理，对母婴福利负责。
