A Conundrum Waiting for Clinical, Technical, and Medico-Legal Solutions: Looking for the “Perfect Biomarker” of Perinatal Asphyxia

This chapter addresses the more recent discovery of “-omic” putative biomarkers of perinatal asphyxia. The urgent need for more tools to intercept as early as possible the onset of hypoxic and/or ischemic signs of brain damage in a fetus or in a newborn is paramount due to the available treatment by therapeutic hypothermia. The precocious identification of neonates who will benefit from this treatment may help physicians to reduce, if not eliminate, the burden of the disability these human beings will carry on for all their lives. Genomics, proteomics, transcriptomics, and metabolomics promise to be able to unravel the complex network of physiological and pathological alteration caused by the primary hypoxic insult. A more in-depth understanding of these mechanisms will guarantee the identification, validation, and implementation of new diagnostic tests able to obtain an early diagnosis (biomarker of damage) and a more accurate prognosis (biomarker of outcome). This comprehension may also pave the way to new neuroprotective drugs and/or treatment, targeted to inhibit or limit primary and secondary damages activated by the abrupt shortening of available oxygen. Although promising, all the so far published “putative” biomarkers failed in the routine application in the neonatal field mainly due to the temporal gap existing between the onset of hypoxia–ischemia and the first diagnosis, which requests an in-depth clinical evaluation and further instrumental analysis.