Timing Perinatal Hypoxic–Ischemic Brain Injury

Perinatal brain injury is a significant contributor to cerebral palsy, epilepsy, and other neurological disorders, occurring from 20 weeks’ gestation to 28 days postnatally. Approximately 40% of cases are associated with premature birth, whereas 11% result from acute intrapartum hypoxia–ischemia (HI). Despite improvements in neonatal care, the incidence remains stable, underscoring the need for better early detection methods. There is a critical “window of opportunity” for therapeutic intervention postinsult, with therapeutic hypothermia being the only established neuroprotective therapy for term infants. However, its efficacy is limited, as many infants continue to suffer disabilities despite treatment. The development of robust biomarkers is essential to identify infants at risk for significant brain injury and to evaluate the effectiveness of treatments. This chapter explores existing and novel biomarkers for assessing injury, determining treatability, and predicting long-term outcomes after HI, ultimately aiming to enhance management strategies for affected infants and improve prognostic abilities in clinical practice.