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Neuroprotection from acute brain injury in preterm infants
Michelle Ryan1, Thierry Lacaze-Masmonteil1, Khorshid Mohammad1
1Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario.
Insights
Protecting preterm infants from brain injury is crucial. Strategies before, during, and after birth can significantly reduce the risk of intracranial injuries in infants born at 32 weeks gestation or earlier.
Area of Science:
- Neonatal neurology
- Perinatal medicine
- Pediatric critical care
Background:
- Infants born at or before 32 weeks gestation face elevated risks of intracranial injuries.
- These injuries, encompassing ischemic and hemorrhagic types, frequently manifest within the initial 72 hours post-birth.
Purpose of the Study:
- To outline antenatal, perinatal, and postnatal neuroprotective strategies for preterm infants.
- To emphasize the combined efficacy of these interventions in preventing acute brain injuries.
Main Methods:
- Review of antenatal interventions: maternal corticosteroids, antibiotics for chorioamnionitis.
- Summary of perinatal practices: tertiary center delivery, delayed cord clamping, hypothermia prevention.
- Outline of postnatal care: antibiotics for suspected chorioamnionitis, cautious inotrope use, PCO2 stability, neutral head positioning.
Main Results:
- Multiple strategies exist across different stages of care to mitigate brain injury risk.
- Combined application of these neuroprotective measures is key.
Conclusions:
- Awareness and implementation of combined neuroprotective policies are essential for clinicians.
- Proactive management can significantly improve outcomes for high-risk preterm infants.
Abstract:
Infants born at ≤32+6 weeks gestation are at higher risk for intracranial ischemic and hemorrhagic injuries, which often occur in the first 72 hours postbirth. Antenatal strategies to reduce the incidence of acute brain injuries include administering maternal corticosteroids and prompt antibiotic treatment for chorioamnionitis. Perinatal strategies include delivery within a tertiary centre, delayed cord clamping, and preventing hypothermia. Postnatal strategies include empiric treatment with antibiotics when chorioamnionitis is suspected, the cautious use of inotropes, the avoidance of blood PCO2 fluctuation, and neutral head positioning. Clinicians should be aware of the policies and procedures that, especially when combined, can provide neuroprotection for preterm infants.
