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Published on: November 20, 2015
Pathogenesis, neuroimaging and management in children with cerebral palsy born preterm
Alexander H Hoon1, Andreia Vasconcellos Faria
1Johns Hopkins University School of Medicine, Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland. Hoon@kennedykrieger.org.
Insights
Premature infants face risks of brain injury, including white matter (WM) damage, despite improved care. Understanding the links between causes, brain damage, and clinical outcomes is key for effective cerebral palsy interventions.
Area of Science:
- Neuroscience
- Perinatal Medicine
- Pediatric Neurology
Background:
- Advances in obstetric care have reduced intraventricular hemorrhage in premature infants.
- Periventricular leukomalacia and neuronal-axonal injury remain significant concerns in preterm neonates.
- The preterm brain, particularly white matter (WM), is vulnerable to injury between 23-34 weeks gestation due to immature vasculature.
Purpose of the Study:
- To highlight the evolving landscape of brain injury in preterm infants.
- To emphasize the role of white matter (WM) injury and neuronal-axonal disease.
- To underscore the importance of understanding the causal chain from etiology to clinical phenotype for effective management.
Main Methods:
- Review of current understanding of preterm brain injury mechanisms.
- Discussion of the vulnerability of oligodendrocytes to free radicals, glutamate, and inflammatory cytokines.
- Highlighting the utility of advanced neuroimaging, such as diffusion tensor imaging (DTI), for assessing injury extent and location.
Main Results:
- Intraventricular hemorrhage incidence has decreased.
- Periventricular leukomalacia and broader white matter (WM) injury, including neuronal-axonal disease, are critical concerns.
- Diffusion tensor imaging (DTI) offers detailed insights into the location and severity of brain damage.
Conclusions:
- Effective management of cerebral palsy in preterm infants requires a comprehensive understanding of the injury pathway.
- Linking etiological factors, neuroimaging findings, and clinical presentation is crucial for targeted interventions.
- Further research into the mechanisms and imaging of preterm brain injury will improve clinical outcomes.
Abstract:
With advances in obstetric and perinatal management, the incidence of intraventricular hemorrhage in premature infants has declined, while periventricular leukomalacia remains a significant concern. It is now known that brain injury in children born preterm also involves neuronal-axonal disease in supratentorial and infratentorial structures. The developing brain is especially vulnerable to white matter (WM) injury from 23 to 34 weeks gestation when blood vessels serving the periventricular WM are immature. Oligodendrocyte progenitors, which are beginning to form myelin during this time, are susceptible to attack from oxygen free radicals, glutamate, and inflammatory cytokines. Advances in imaging techniques such as diffusion tensor imaging provide a more complete picture of the location and extent of injury. Effective management of children born preterm with cerebral palsy is predicated on an understanding of sequential links from etiological antecedents to brain neuropathology as revealed with neuroimaging techniques to clinical phenotypes, toward focused interventions with measurable outcomes.
