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Published on: November 20, 2015
Protecting the brain of the micropreemie
S M Boyd1, S J Tapawan2, N Badawi3
1Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia; Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.
Insights
Protecting the extremely preterm infant brain is crucial. Evidence-based neuroprotection strategies, from prenatal care to neonatal interventions, aim to improve survival without disability and long-term quality of life.
Area of Science:
- Neonatalogy and Perinatal Medicine
- Developmental Neuroscience
- Pediatric Neurology
Background:
- Substantial improvements in survival rates for extremely preterm infants have been achieved.
- Protecting the developing brain and mitigating neurodevelopmental sequelae are critical priorities.
- Minimizing ischemia and inflammation is key to preventing brain injury, especially white matter damage.
Purpose of the Study:
- To review evidence-based interventions for neuroprotection in extremely preterm infants.
- To highlight the importance of avoiding complications that trigger brain injury.
- To outline strategies for optimizing long-term outcomes through surveillance and early intervention.
Main Methods:
- Review of existing evidence-based interventions for neuroprotection.
- Discussion of strategies including prevention of preterm birth, antenatal care, and neonatal support.
- Emphasis on avoiding ischemia and inflammation-inducing complications.
Main Results:
- Multiple evidence-based interventions exist for neuroprotection in extremely preterm infants.
- Antenatal care, optimized neonatal transition, and developmental care are crucial.
- Avoiding complications like ischemia and inflammation is vital for brain development.
Conclusions:
- Neurodevelopmental surveillance, early diagnosis, and intervention are essential for optimizing outcomes.
- Further research is needed on neuroprotective agents and common neonatal interventions.
- Improving neurodevelopmental outcomes in extremely preterm infants remains a key focus.
Abstract:
Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developmental care. Avoidance of complications that trigger ischemia and inflammation is vital for minimizing brain dysmaturation and injury, particularly of the white matter. Neurodevelopmental surveillance, early diagnosis of cerebral palsy and early intervention are essential for optimizing long-term outcomes and quality of life. Research priorities include further evaluation of putative neuroprotective agents, and investigation of common neonatal interventions in trials adequately powered to assess neurodevelopmental outcome.
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