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Published on: November 20, 2015
Late preterm babies and the risk of neurological damage
1Neonatal Intensive Care Unit, Istituto Giannina Gaslini IRCCS, Genova, Italy. patologianeonatale@ospedale-gaslini.ge.it.
Insights
Late preterm infants face increased brain injury risks and developmental delays compared to full-term babies. Subtle clinical signs of impairment are often missed, necessitating improved detection methods for these vulnerable infants.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neuroimaging
Background:
- Late preterm infants (34-36 weeks gestation) represent a growing proportion of premature births.
- This group exhibits heightened vulnerability to brain insults, including conditions typically seen in both extremely preterm and term infants.
- Neurological impairments may occur in late preterm infants even without detectable brain lesions on advanced imaging.
Purpose of the Study:
- To investigate the unique neurological vulnerabilities of late preterm infants.
- To explore the reasons behind the increased risk of developmental delay in this population.
- To emphasize the need for improved clinical assessment skills for subtle neurological impairments.
Main Methods:
- Review of existing literature on late preterm infant brain development and injury.
- Analysis of neuroimaging findings in relation to clinical outcomes.
- Discussion of clinical observation limitations in standard neonatal nurseries.
Main Results:
- Late preterm infants are susceptible to a wide spectrum of brain lesions.
- Cortical volume increases and subplate neuron connectivity finalize during this period.
- A significant risk (up to 36%) of developmental delay or disability exists compared to term infants.
Conclusions:
- Sophisticated neuroimaging alone is insufficient to fully understand the risks faced by late preterm infants.
- Enhanced clinical skills are crucial for identifying subtle neurological impairments in this vulnerable group.
- Improved diagnostic approaches are needed to address the higher rates of developmental issues in late preterm infants.
Abstract:
Late preterm infants (born between 34+0 and 36+6 weeks gestation) account for the recent striking increase in premature birth and they carry a higher vulnerability to suffer brain insults compared to term infants. These babies can develop any kind of known brain lesions including those affecting the most premature babies (i.e.an intraventricular haemorrhage) and lesions affecting more typically term babies like asphyxia and stroke. In other words there is not a specific brain lesion characterizing this gestational age group, and there is not a specific maturational landmark although "subplate neurons" are suppose to ultimate their connectivity in this period and the cortical volume is significantly increasing. In addition we should not forget the possibility that "late preterm babies" may present neurological clinical impairments in the absence of recognized morphological brain lesions even with the use of highly sophisticated MR imaging techniques. For these reasons a wider use of more sophisticated neuro radiological studies is not sufficient to better understand why some studies highlight that the risk of developmental delay or disability can reach 36% higher among late preterm infants compared with term infants. We believe we should improve also our skills to identify even those very subtle clinical signs of impairment deserving further investigations although we often admit these babies in the normal post natal nurseries where clinical observation cannot be so appropriate.
