Figure 1.

Antagonistic molecular and cell cascades elicited by perinatal asphyxia. There are two important molecular and cell cascades elicited by perinatal hypoxic insults, one leading to removal of cells damaged by the reduced supply of oxygen, implying activation of ubiquitination, peroxisomal, and caspase pathways, resulting in apoptosis or necrosis, the latter encompassing mild to severe inflammation. The other cascade is activated for compensating cell loss by multiple mechanisms of DNA repair. Naturally occurring nicotinamide with its various mechanisms of action could support these compensatory mechanisms if given systemically as a therapeutic means. In any case, both cell loss and cell rescue eventually entail more or less subtle consequences on brain development, neuronal wiring, and neuron glia interactions. These tentatively negative consequences are probably reinforced by additional negative impact during development (puberty and adolescence), resulting in psychiatric disorders if not aggravating neurological deficits.