Abstract
Preterm birth (PTB), defined as parturition prior to 37 weeks of gestation, is the leading cause of morbidity and mortality in the neonatal population. The incidence and severity of complications of prematurity increase with decreasing gestational age and birthweight. The aim of this review study is to select the most current evidence on the role of oxidative stress in the onset of preterm complication prevention strategies and treatment options with pre-clinical and clinical trials. We also provide a literature review of primary and secondary studies on the role of oxidative stress in preterm infants and its eventual treatment in prematurity diseases. We conducted a systematic literature search of the Medline (Pubmed), Scholar, and ClinicalTrials.gov databases, retroactively, over a 7-year period. From an initial 777 articles identified, 25 articles were identified that met the inclusion and exclusion criteria. Of these, there were 11 literature reviews: one prospective cohort study, one experimental study, three case-control studies, three pre-clinical trials, and six clinical trials. Several biomarkers were identified as particularly promising, such as the products of the peroxidation of polyunsaturated fatty acids, those of the oxidation of phenylalanine, and the hydroxyl radicals that can attack the DNA chain. Among the most promising drugs, there are those for the prevention of neurological damage, such as melatonin, retinoid lactoferrin, and vitamin E. The microbiome also has an important role in oxidative stress. In conclusion, the most recent studies show that a strong relationship between oxidative stress and prematurity exists and that, unfortunately, there is still little therapeutic evidence reported in the literature.
Highlights
Preterm birth (PTB), defined as parturition prior to 37 weeks of gestation, is the leading cause of morbidity and mortality in the neonatal population
Given the absence of evidence for the treatment of oxidative stress in the preterm, we have selected three pre-clinical trials that evaluate the use of certain molecules able to prevent the development of neurological, gastroenteric, and respiratory complications (Table 2)
A high abundance of Terrisporobacter and Peptoclostridium and low bacterial diversity might be associated with increased oxidative stress in infants who are fed formula [15]. These results show that feeding practices affect the bacterial diversity and composition of the gut microbiome, which is associated with oxidative stress in the very low birth weight (VLBW) of preterm infants [8,45]
Summary
Preterm birth (PTB), defined as parturition prior to 37 weeks of gestation, is the leading cause of morbidity and mortality in the neonatal population. The incidence and severity of complications of prematurity increase with decreasing gestational age and birthweight. About 15 million babies are premature (more than one in ten of all babies born around the world). Multiple prospective studies have reported that premature newborns have higher risks of long-term neurodevelopmental disabilities, such as intellectual disability (ID), blindness, neurosensorial hearing loss, and cerebral palsy (CP). There are several risk factors accounting for prematurity, such as assisted reproductive technologies that increase the rate of multiple births (twins, triplets, or quadruples) and advanced maternal age [2]. Other maternal causes potentially related to premature births are inflammatory, hormonal, and neurochemical pathologies that could influence a mother’s ability to take appropriate care of the baby once born [4]
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