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Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances

Joseph J Volpe1

  • 1Department of Neurology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA. joseph.volpe@childrens.harvard.edu

The Lancet. Neurology
|December 17, 2008
PubMed

Insights

Brain injury in premature infants, known as encephalopathy of prematurity, involves white matter damage and neuronal injury. This review explores its complex causes and impact on neurodevelopmental disabilities.

Area of Science:

  • Neonatal neurology
  • Developmental neuroscience
  • Pediatric neurosurgery

Background:

  • Premature infant brain injury poses significant public health challenges, leading to severe neurodevelopmental deficits.
  • Traditionally viewed as periventricular leukomalacia (PVL), this injury is now understood to involve broader neuronal and axonal damage.

Purpose of the Study:

  • To review current understanding of brain injury in premature infants.
  • To integrate new insights into brain injury and development during human prematurity.
  • To propose the term "encephalopathy of prematurity" for this complex condition.

Main Methods:

  • Literature review integrating recent findings on brain injury and development.
  • Analysis of the pathophysiology of periventricular leukomalacia (PVL) and neuronal/axonal disease.
  • Synthesis of evidence on maturational and trophic disturbances in the premature brain.

Main Results:

  • Periventricular leukomalacia (PVL) is frequently accompanied by neuronal/axonal disease affecting multiple brain regions.
  • This combined pathology, termed "encephalopathy of prematurity," includes cerebral white matter, thalamus, basal ganglia, cortex, brain stem, and cerebellum.
  • The condition is a complex mix of primary destructive processes and secondary maturational/trophic issues.

Conclusions:

  • Encephalopathy of prematurity is a more comprehensive description of brain injury in premature infants.
  • Understanding this complex condition requires integrating knowledge of both injury and development.
  • Further research is needed to address the significant neurodevelopmental disabilities associated with this injury.

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