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Published on: October 28, 2022
Neuroprotection of the preterm brain
Bobbi Fleiss1, Pierre Gressens1
1NeuroDiderot, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Division of Imaging Sciences and Biomedical Engineering, Centre for the Developing Brain, King's College London, London, United Kingdom.
Insights
Neuroprotective strategies are crucial for preterm infants facing lifelong deficits. Current treatments like magnesium sulfate and caffeine have limited efficacy, necessitating novel therapeutic approaches for improved outcomes in neonates.
Area of Science:
- Neonatal neurology
- Developmental neuroscience
- Pediatric neuroprotection
Background:
- Preterm infants often experience long-term cognitive, behavioral, and motor deficits despite advances in neonatal care.
- Existing neuroprotective strategies are insufficient, highlighting a critical gap in managing these vulnerable neonates.
- Current interventions like magnesium sulfate and caffeine offer limited benefits and variable administration.
Purpose of the Study:
- To review the current challenges and bottlenecks in developing effective neuroprotective strategies for preterm neonates.
- To explore innovative therapeutic avenues and delayed interventions to improve neurodevelopmental outcomes.
- To address the unmet need for robust neuroprotection in fragile preterm infants.
Main Methods:
- Review of current literature on preterm infant neurodevelopmental deficits.
- Analysis of existing and potential neuroprotective agents and their mechanisms.
- Examination of modern epidemiological data, neuroimaging, and experimental models.
- Discussion of bottlenecks hindering progress in the field.
Main Results:
- Significant proportion of preterm neonates suffer from persistent neurodevelopmental impairments.
- Current pharmacological interventions (magnesium sulfate, caffeine) show limited efficacy and inconsistent use.
- There is a clear need for more specific and effective neurotherapeutic strategies.
Conclusions:
- Novel and specific neurotherapeutic strategies are urgently required to enhance outcomes for preterm infants.
- Addressing pathophysiologic mechanisms with modern research approaches is essential.
- Exploring innovative interventions, including delayed strategies, holds promise for improving neuroprotection.
Abstract:
Despite notable advances in the care and survival of preterm infants, a significant proportion of preterm neonates will have life-long cognitive, behavioral, and motor deficits, and robustly effective neuroprotective strategies are still missing. These therapies must target the pathophysiologic mechanisms observed in contemporaneous infants and rely on modern epidemiology, imaging, and experimental models and assessment techniques. Two drugs, magnesium sulfate and caffeine, are already in use in several units, and although their targets are apnea of prematurity and myometrial contractility (respectively), they do offer improved odds of positive outcomes. Nevertheless, these drugs have limited efficacy, and NICU-to-NICU administration varies greatly. As such, there is an obvious need for additional specific neurotherapeutic strategies to further enhance the outcome of this very fragile population of neonates. The chapter reviews these issues, highlights bottlenecks that need to be solved for meaningful progress in the field, and proposes future innovative avenues for intervention, including delayed interventions.
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