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Obstetrics and Gynecology International
Volume 2018, Article ID 2120835, 12 pages
https://doi.org/10.1155/2018/2120835
Research Article

White Matter Damage in 4,725 Term-Born Infants Is Determined by Head Circumference at Birth: The Missing Link

1Campus Clinic Gynecology, Ruhr-University Bochum, Universitätsstr. 140, 44799 Bochum, Germany
2Department of Obstetrics & Gynecology, Klinikum Wilhelmshaven, Friedrich-Paffrath-Straße 100, 26389 Wilhelmshaven, Germany

Correspondence should be addressed to Arne Jensen; ed.bur@nesnej.enra

Received 14 September 2017; Revised 16 November 2017; Accepted 22 November 2017; Published 28 February 2018

Academic Editor: Curt W. Burger

Copyright © 2018 Arne Jensen and Bert Holmer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. White matter damage (WMD) is a prime risk factor for cerebral palsy, in part occurring unexplained. Though primarily a problem of preterm infants, there is growing evidence that in large newborns cephalopelvic disproportion and prolonged labor are involved. Objective. To explore both incidence of and morphometric risk factors for WMD in term-born infants. Study Design. We related growth variables and risk factors of term-born infants to WMD (61/4,725) using odds ratios of z-score bands. Results. The key result is the novel observation that head circumference is a prime and unique index for WMD in term-born neonates over the whole range of centiles (U-shaped; WMD (%) = 3.1168–0.12797HC (centile) + 0.0014741HC2; ). This suggests different mechanisms for WMD in the lowest and highest z-score band. In the latter, cephalic pressure gradients and prolonged labor with preserved neonatal vitality prevail, whereas in the previous one, acute and chronic oxygen deprivation with reduced vitality predominate. Conclusions. The fact that seemingly healthy term-born neonates are not screened by head imaging, in spite of both large head circumference and prolonged labor, is considered to be the missing link between the insult that escapes diagnosis and the development of unexplained developmental delay and cerebral palsy in childhood.