Abstract
Many preterm neonates require mechanical ventilation which increases the risk of cerebral inflammation and white matter injury in the immature brain. In this review, we discuss the links between ventilation and brain injury with a focus on the immediate period after birth, incorporating respiratory support in the delivery room and subsequent mechanical ventilation in the neonatal intensive care unit. This review collates insight from large animal models in which acute injurious ventilation and prolonged periods of ventilation have been used to create clinically relevant brain injury patterns. These models are valuable resources in investigating the pathophysiology of ventilation-induced brain injury and have important translational implications. We discuss the challenges of reconciling lung and brain maturation in commonly used large animal models. A comprehensive understanding of ventilation-induced brain injury is necessary to guide the way we care for preterm neonates, with the goal to improve their neurodevelopmental outcomes.
Highlights
Respiratory support is a necessary life-saving intervention which has been associated with brain injury, especially in preterm neonates
A cohort study in South Korea reported that 38.5% of very low birth weight (VLBW) preterm infants received >7 days of mechanical ventilation [35]
Prolonged periods of mechanical ventilation increases the risks of intraventricular hemorrhage (IVH) [4, 22], periventricular leukomalacia or white matter injury [4, 6, 19, 35, 37], cerebral palsy [14], and attention deficit hyperactivity disorder [14] in preterm infants
Summary
Respiratory support is a necessary life-saving intervention which has been associated with brain injury, especially in preterm neonates. Many complications associated with prematurity are due to an interruption of normal organ development that would otherwise proceed to term in utero. For this reason, the distinction of babies by gestational age (GA) at birth—extremely preterm (
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