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Published on: November 20, 2015
Protecting the premature brain: current evidence-based strategies for minimising perinatal brain injury in preterm
Charlotte L Lea1,2, Adam Smith-Collins1,2, Karen Luyt1,2
1Department of Neonatal Neuroscience, St Michael's Hospital, Bristol, UK.
Insights
Improving neurodevelopmental outcomes for preterm infants remains a critical neonatal medicine challenge. Evidence-based neuroprotective care strategies are underutilized, despite promising research for neonatal brain injury reduction.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Perinatal Research
Background:
- Preterm birth significantly disrupts infant brain development, leading to physical and cognitive impairments.
- While survival rates for preterm infants have improved, neurodevelopmental outcomes and severe disability rates have not, increasing the overall number of children with neurodisability.
- Novel therapies show promise, but current, evidence-based neuroprotective interventions are often underutilized.
Purpose of the Study:
- To review and collate evidence on the efficacy of current neuroprotective interventions for preterm infants.
- To address barriers hindering the uptake of proven treatments and the translation of research into clinical practice.
- To explore future directions in preterm neuroprotective care.
Main Methods:
- Systematic review of evidence supporting interventions recommended by guidelines or large meta-analyses/randomized control trials.
- Analysis of controversies and practical challenges impacting the implementation of neuroprotective strategies.
- Discussion of future research and clinical practice advancements.
Main Results:
- Evidence supports the efficacy of various interventions in improving neurodevelopmental outcomes and reducing neonatal brain injury.
- Identified significant barriers to clinical adoption, including controversies and practical implementation issues.
- Highlighted the need for better translation of research findings into routine care.
Conclusions:
- Optimizing neurodevelopmental outcomes in preterm infants requires better utilization of established neuroprotective care strategies.
- Addressing implementation barriers is crucial for translating research into improved clinical practice.
- Continued research and focus on future advancements are essential for advancing preterm infant neuroprotection.
Abstract:
Improving neurodevelopmental outcome for preterm infants is an important challenge for neonatal medicine. The disruption of normal brain growth and neurological development is a significant consequence of preterm birth and can result in physical and cognitive impairments. While advances in neonatal medicine have led to progressively better survival rates for preterm infants, there has only been a modest improvement in the proportion of surviving infants without neurological impairment, and no change in the proportion with severe disability. The overall number of children with neurodisability due to prematurity is increasing. Trials investigating novel therapies are underway and many have promising early results; however, in the interim, current treatments and management strategies that have proven benefit for neurodevelopment or reduction in neonatal brain injury are often underutilised. We collate the evidence for the efficacy of such interventions, recommended by guidelines or supported by large meta-analysis or randomised control trials. We address controversies that have hindered uptake and problems with translating research into practice. We then look to the future of preterm neuroprotective care.
