Hypoxic-ischemic brain injury in the newborn: pathophysiology and potential strategies for intervention.

There is increasing clinical and experimental data describing the evolution of hypoxic-ischemic encephalopathy in the perinatal period. Outcome to the fetus is determined not only by the impact of gross asphyxial insult, but also external factors that sensitize the brain to injury. Delayed neuronal and glial death occurring in the hours and days after the insult by apoptotic and related processes are observed following severe injury, and offer the most promise for pharmacological intervention. Furthermore, new technologies allow the identification of subtle insults with evolving encephalopathies that have implications for long-term neurological outcome. Application of this knowledge will allow us to identify strategies for early intervention and prevent the course of damage caused by hypoxic-ischemic injury.