. . .
4 - Outcome after asphyxia at birth
The inferior colliculi were prominently damaged in
monkeys subjected to asphyxia at birth [1, 2]. This
damage was part of what Myers (1972) referred to as
"a monotonous rank order of brainstem nuclei" [2].
Impairment of brainstem structures was not viewed
with an appropriate sense of alarm. A lapse in
respiration at birth is generally considered harmless.
In experiments with monkeys resuscitation was only
required after about eight minutes of asphyxia at
birth. Four to six minutes of oxygen deprivation at
birth may go completely unnoticed, especially if the
Apgar score by five minutes after birth appears
adequate.
One of the problems, still today, is that outcomes of
difficult birth and early developmental delay are not
investigated into adulthood. No one wants to admit to
low Apgar scores, and parents are admonished if
they worry about developmental delay. Pediatricians
can stipulate "normal limits" for stages of motor and
language development, but who can be complacent
about their own child's delay in learning to roll over,
sit, crawl, stand, walk, or talk?
Even in monkeys who recovered from asphyxia
without the need for resuscitation, Faro and Windle
(1969) found “transneuronal degeneration” (or
decreased numbers of neurons in wide areas of the
brain) following survival for months or years [3]. No
visible damage to the brain had at first been detected
in monkeys subjected to briefer periods (4 to 6
minutes) of asphyxia. The over-optimistic notion of
infant "brain plasticity" needs to be questioned. The
evidence indicates just the opposite. Every effort
must be made to avoid injury or compromise of the
infant brain. The paper by Faro and Windle was
published in the journal Experimental Neurology, and
is now available online as a PDF file. I have included
it here because of the great importance of the data
reported.
Monkeys subjected to asphyxia at birth were
developmentally delayed, but appeared to "catch
up." Windle (1969) did warn that although the
asphyxiated animals became more normal with time,
their brains were damaged, this damage was
permanent, and disrupted maturation of the cerebral
cortex [1]. Lack of good manual dexterity was a
persistent problem in monkeys that otherwise
appeared to fully recover. Manual dexterity is often a
problem for children with autism. Large, laboriously
produced hand-writing is often observed even in high-
functioning adults with autism [4].
Manual dexterity develops and comes under control
from an area in the precentral gyrus of the cortex that
is close to the locus from which movements of the
tongue and other oral components are initiated (see
figure 3). Fingers, thumb, lips, jaw and tongue are
controlled from an area of the precentral gyrus
adjacent to the speech production region of the
frontal cortex (Broca’s area) [5]. Maturation of these
areas of close proximity in the cerebral cortex may
depend upon integrity of interconnected circuits of
the brainstem [6].
The major difference between monkeys and humans
is that monkeys do not learn to speak. Therefore,
damage of the auditory system by asphyxia at birth
may not interfere that much with development of a
monkey. But language development is of primary
importance for the human child. The importance of
auditory acuity for normal language development
should go without saying. Children with autism do
exhibit problems with hearing; the speech they
acquire lacks normal intonation. Echoing of
prefabricated phrases may sound like perfect
imitations, but failure to change intonation to fit a new
context is as bizarre as failing to reword the phrase.
Damage to the auditory system is serious for a
human infant, and should be recognized as a
possible consequence of any complication at birth.
That the damage of brainstem auditory nuclei is not
static, but affects maturational growth throughout the
brain, makes it even more imperative that every effort
be made to prevent any lapse in respiration at birth.
Low Apgar scores at birth should be regarded as
ominous. Early recognition and intervention for
developmental delays cannot be expected to make
up for the effects of oxygen insufficiency at birth.
The inferior colliculi were prominently damaged in
monkeys subjected to asphyxia at birth [1, 2]. This
damage was part of what Myers (1972) referred to as
"a monotonous rank order of brainstem nuclei" [2].
Impairment of brainstem structures was not viewed
with an appropriate sense of alarm. A lapse in
respiration at birth is generally considered harmless.
In experiments with monkeys resuscitation was only
required after about eight minutes of asphyxia at
birth. Four to six minutes of oxygen deprivation at
birth may go completely unnoticed, especially if the
Apgar score by five minutes after birth appears
adequate.
One of the problems, still today, is that outcomes of
difficult birth and early developmental delay are not
investigated into adulthood. No one wants to admit to
low Apgar scores, and parents are admonished if
they worry about developmental delay. Pediatricians
can stipulate "normal limits" for stages of motor and
language development, but who can be complacent
about their own child's delay in learning to roll over,
sit, crawl, stand, walk, or talk?
Even in monkeys who recovered from asphyxia
without the need for resuscitation, Faro and Windle
(1969) found “transneuronal degeneration” (or
decreased numbers of neurons in wide areas of the
brain) following survival for months or years [3]. No
visible damage to the brain had at first been detected
in monkeys subjected to briefer periods (4 to 6
minutes) of asphyxia. The over-optimistic notion of
infant "brain plasticity" needs to be questioned. The
evidence indicates just the opposite. Every effort
must be made to avoid injury or compromise of the
infant brain. The paper by Faro and Windle was
published in the journal Experimental Neurology, and
is now available online as a PDF file. I have included
it here because of the great importance of the data
reported.
Monkeys subjected to asphyxia at birth were
developmentally delayed, but appeared to "catch
up." Windle (1969) did warn that although the
asphyxiated animals became more normal with time,
their brains were damaged, this damage was
permanent, and disrupted maturation of the cerebral
cortex [1]. Lack of good manual dexterity was a
persistent problem in monkeys that otherwise
appeared to fully recover. Manual dexterity is often a
problem for children with autism. Large, laboriously
produced hand-writing is often observed even in high-
functioning adults with autism [4].
Manual dexterity develops and comes under control
from an area in the precentral gyrus of the cortex that
is close to the locus from which movements of the
tongue and other oral components are initiated (see
figure 3). Fingers, thumb, lips, jaw and tongue are
controlled from an area of the precentral gyrus
adjacent to the speech production region of the
frontal cortex (Broca’s area) [5]. Maturation of these
areas of close proximity in the cerebral cortex may
depend upon integrity of interconnected circuits of
the brainstem [6].
The major difference between monkeys and humans
is that monkeys do not learn to speak. Therefore,
damage of the auditory system by asphyxia at birth
may not interfere that much with development of a
monkey. But language development is of primary
importance for the human child. The importance of
auditory acuity for normal language development
should go without saying. Children with autism do
exhibit problems with hearing; the speech they
acquire lacks normal intonation. Echoing of
prefabricated phrases may sound like perfect
imitations, but failure to change intonation to fit a new
context is as bizarre as failing to reword the phrase.
Damage to the auditory system is serious for a
human infant, and should be recognized as a
possible consequence of any complication at birth.
That the damage of brainstem auditory nuclei is not
static, but affects maturational growth throughout the
brain, makes it even more imperative that every effort
be made to prevent any lapse in respiration at birth.
Low Apgar scores at birth should be regarded as
ominous. Early recognition and intervention for
developmental delays cannot be expected to make
up for the effects of oxygen insufficiency at birth.
- Windle WF (1969) Brain
damage by asphyxia at birth. - Myers RE (1972) Two patterns
of perinatal brain damage and
their conditions of occurrence. - Faro MD & Windle WF (1969)
Transneuronal degeneration in
brains of monkeys asphyxiated
at birth. - Beversdorf DQ et al. (2001)
Brief report: macrographia in
high-functioning adults with
autism spectrum disorder. - Buccino G et al. (2004)The
mirror neuron system and
action recognition. - Hamzei F et al. (2003) The
human action recognition
system and its relationship to
Broca's area: an fMRI study.
| Figure 3 |
| "motor homunculus" from: http://www.brainconnection.com/ Diagram showing locations in the motor cortex from which actions are initiated. The orderly development of these control centers occurs under guidance of trophic neurotransmitters produced in the much earlier maturing brainstem circuits that are vulnerable to impairment by oxygen insufficiency at birth. |
- Windle WF (1969) Brain damage by asphyxia at birth. Scientific American 221(#4):76-
84. - Myers RE (1972) Two patterns of perinatal brain damage and their conditions of
occurrence. American Journal of Obstetrics and Gynecology 112:246-276. - .Faro MD & Windle WF (1969) Transneuronal degeneration in brains of monkeys
asphyxiated at birth. Experimental Neurology 24:38-53. - Beversdorf DQ, Anderson JM, Manning SE, Anderson SL, Nordgren RE, Felopulos GJ,
Bauman ML. Brief report: macrographia in high-functioning adults with autism spectrum
disorder. J Autism Dev Disord. 2001 Feb;31(1):97-101. - Buccino G, Binkofski F, Riggio L. (2004)The mirror neuron system and action
recognition. Brain Lang. 2004 May;89(2):370-6. - Hamzei F, Rijntjes M, Dettmers C, Glauche V, Weiller C, Buchel C. (2003) The human
action recognition system and its relationship to Broca's area: an fMRI study.
Neuroimage. 2003 Jul;19(3):637-44.
Localization of motor
control in the cortex
control in the cortex
PDF file: Faro & Windle, 1969
(abnormal maturation of the brain
in monkeys asphyxiated at birth.)
(abnormal maturation of the brain
in monkeys asphyxiated at birth.)