Abstract
Preterm birth is associated with a high risk of morbidity and mortality including brain damage and cerebral palsy. The development of brain injury in the preterm infant may be influenced by many factors including perinatal asphyxia, infection/inflammation, chronic hypoxia and exposure to treatments such as mechanical ventilation and corticosteroids. There are currently very limited treatment options available. In clinical trials, magnesium sulfate has been associated with a small, significant reduction in the risk of cerebral palsy and gross motor dysfunction in early childhood but no effect on the combined outcome of death or disability, and longer-term follow up to date has not shown improved neurological outcomes in school-age children. Recombinant erythropoietin has shown neuroprotective potential in preclinical studies but two large randomized trials, in extremely preterm infants, of treatment started within 24 or 48 h of birth showed no effect on the risk of severe neurodevelopmental impairment or death at 2 years of age. Preclinical studies have highlighted a number of promising neuroprotective treatments, such as therapeutic hypothermia, melatonin, human amnion epithelial cells, umbilical cord blood and vitamin D supplementation, which may be useful at reducing brain damage in preterm infants. Moreover, refinements of clinical care of preterm infants have the potential to influence later neurological outcomes, including the administration of antenatal and postnatal corticosteroids and more accurate identification and targeted treatment of seizures.
Highlights
Introduction to Preterm Brain InjuryPremature birth, defined as birth before 37 weeks completed gestation, represents11.1% of all live births worldwide
Hypoxia-ischemia (HI) before, during or shortly after birth can contribute to brain injury in at least some preterm infants [2–4]
In addition to acute HI as discussed above, many preterm infants are exposed to chronic hypoxia before birth, as shown by intrauterine growth restriction (IUGR)/small for gestational age (SGA), defined as birthweight below the 10th percentile [10]
Summary
Premature birth, defined as birth before 37 weeks completed gestation, represents. 11.1% of all live births worldwide. Premature birth, defined as birth before 37 weeks completed gestation, represents. The rate of premature birth increased in almost all countries from 1990 to 2010 [1]. The mortality after preterm birth has fallen steadily over time, preterm infants continue to have very high rates of neurodevelopmental disability, including severe motor disorders such as cerebral palsy. One of the most prevalent risk factors for perinatal brain injury is preterm birth itself, which may result from or interact with perinatal environmental and genetic factors. Disruption of nutrient or oxygen supply can arise from maternal (e.g., nutrient deficiencies, anemia), maternal–fetal (e.g., placental development) or fetal (e.g., abnormal vasculature, metabolic disorders) causes
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