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Although brain injury is multifactorial, particularly after preterm birth, acute hypoxia\u2013ischaemia is a major contributor to injury. It is now well established that the severity of injury after hypoxia\u2013ischaemia is determined by a dynamic balance between injurious and protective processes. In addition, mothers who are at risk of premature delivery have high rates of diabetes and antepartum infection\/inflammation and are almost universally given treatments such as antenatal glucocorticoids and magnesium sulphate to reduce the risk of death and complications after preterm birth. We review evidence that these common factors affect responses to fetal asphyxia, often in unexpected ways. For example, glucocorticoid exposure dramatically increases delayed cell loss after acute hypoxia\u2013ischaemia, largely through secondary hyperglycaemia. 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