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Updated: Aug 18, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Clinical measures to preserve cerebral integrity in preterm infants
Ursula Felderhoff-Mueser1, Christoph Bührer
1Department of Neonatology, Charité Campus Virchow-Klinikum, Berlin, Germany.
Insights
Preventing brain damage in very preterm infants is crucial. Avoiding postnatal steroids significantly reduced cerebral palsy and neurodevelopmental impairment, highlighting their importance in clinical trials.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Clinical Trials
Background:
- Impaired psychomotor development is a major long-term morbidity in very preterm infants, often following brain injury like intraventricular hemorrhage or periventricular leukomalacia.
- Identifying effective interventions to prevent brain damage and improve neurodevelopmental outcomes in this vulnerable population is critical.
Purpose of the Study:
- To review randomized controlled trials evaluating interventions aimed at reducing brain damage and neurodevelopmental impairment in preterm infants.
- To identify interventions with confirmed efficacy for improving long-term neurodevelopmental outcomes.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) focusing on preterm infants.
- Analysis of interventions targeting the prevention of ultrasound-detected brain injury and neurodevelopmental impairment during follow-up.
- Evaluation of reported effects on intraventricular hemorrhage, cerebral palsy, and psychomotor development.
Main Results:
- Preliminary findings for fresh frozen plasma, ethamsylate, phenobarbitone, and morphine reducing intraventricular hemorrhage were not confirmed in larger trials.
- Early indomethacin may reduce intraventricular hemorrhage but does not impact long-term outcomes. Pancuronium, inositol, and vitamin E showed decreased hemorrhage rates without long-term psychomotor development assessment.
- Thyroxin supplementation did not improve neurodevelopmental outcomes, while protein enrichment and individualized developmental care appeared beneficial. Avoidance of postnatal steroids yielded the largest reductions in cerebral palsy and neurodevelopmental impairment.
Conclusions:
- Avoidance of postnatal steroids is the most effective strategy identified for reducing cerebral palsy and neurodevelopmental impairment in preterm infants.
- Interventions like protein enrichment and individualized developmental care may also be beneficial for neurodevelopmental outcomes.
- Future randomized trials involving preterm infants must incorporate long-term endpoints such as cerebral palsy and neurodevelopmental impairment to accurately assess intervention efficacy.
Abstract:
Impaired psychomotor development, often anteceded by major intraventricular hemorrhage or periventricular leukomalacia, constitutes the most important long-term morbidity of very preterm infants. We reviewed randomized controlled trials aimed at reducing the incidence of brain damage, as detected by ultrasound, or neurodevelopmental impairment during follow-up of preterm infants. Preliminary reports of reduced rates of intraventricular hemorrhage obtained with administration of fresh frozen plasma, ethamsylate, phenobarbitone, or morphine have not been confirmed in subsequent larger trials. Early administration of indomethacin may reduce intraventricular hemorrhage without affecting long-term outcome. Pancuronium, inositol, and vitamin E decreased intraventricular hemorrhage rates but later psychomotor development was not examined. Thyroxin supplementation failed to improve neurodevelopmental outcome while protein enrichment of formula and individualized developmental care appear to be beneficial. The largest reductions in cerebral palsy and neurodevelopmental impairment were achieved by avoidance of postnatal steroids. This finding emphasizes the need to include these late endpoints in any randomized trial involving preterm infants.
