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Published on: November 20, 2015
Pharmacological Neuroprotection of the Preterm Brain: Current Evidence and Perspectives
Tania Siahanidou1, Christina Spiliopoulou2
1Neonatal Unit of the First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Magnesium sulfate and caffeine show neuroprotective effects in preterm infants, improving brain outcomes. Further research is needed for other agents like erythropoietin and melatonin.
Area of Science:
- Neonatal Neurology
- Developmental Neuroscience
- Pharmacology
Background:
- Preterm infants face significant risks of long-term neurodevelopmental and intellectual impairments.
- Developing effective neuroprotective strategies is crucial for improving outcomes in preterm survivors.
Purpose of the Study:
- To review current evidence on pharmacological agents for neuroprotection in the preterm brain.
- To identify promising and established neuroprotective treatments for premature infants.
Main Methods:
- Systematic review of existing literature on pharmacological neuroprotection.
- Analysis of randomized controlled trials and preclinical studies on various agents.
Main Results:
- Magnesium sulfate (antenatal) and caffeine (postnatal) demonstrated neuroprotective effects.
- Erythropoietin showed mixed results; long-term follow-up is necessary.
- Melatonin, neurosteroids, and other agents require further human studies.
Conclusions:
- Magnesium and caffeine are established neuroprotective agents for preterm infants.
- Erythropoietin's long-term neuroprotective role needs further investigation.
- Numerous other pharmacological and cell-based therapies show future potential for preterm brain protection.
Abstract:
Despite improvements in viability, the long-term neurodevelopmental outcomes of preterm babies remain serious concern as a significant percentage of these infants develop neurological and/or intellectual impairment, and they are also at increased risk of psychiatric illnesses later in life. The current challenge is to develop neuroprotective approaches to improve adverse outcomes in preterm survivors. The purpose of this review was to provide an overview of the current evidence on pharmacological agents targeting the neuroprotection of the preterm brain. Among them, magnesium sulfate, given antenatally to pregnant women with imminent preterm birth before 30 to 34 weeks of gestation, as well as caffeine administered to preterm infants after birth, exhibited neuroprotective effects for human preterm brain. Erythropoietin treatment of preterm infants did not result in neuroprotection at 2 years of age in two out of three published large randomized controlled trials; however, long-term follow-up of these infants is needed to come to definite conclusions. Further studies are also required to assess whether melatonin, neurosteroids, inhaled nitric oxide, allopurinol, or dietary supplements (omega-3 fatty acids, choline, curcumin, etc.) could be implemented as neuroprotectants in clinical practice. Furthermore, other pharmacological agents showing promising signs of neuroprotective efficacy in preclinical studies (growth factors, hyaluronidase inhibitors or treatment, antidiabetic drugs, cannabidiol, histamine-H3 receptor antagonists, etc.), as well as stem cell- or exosomal-based therapies and nanomedicine, may prove useful in the future as potential neuroprotective approaches for human preterm brain. KEY POINTS: · Magnesium and caffeine have neuroprotective effects for the preterm brain.. · Follow-up of infants treated with erythropoietin is needed.. · Neuroprotective efficacy of several drugs in animals needs to be shown in humans..
