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Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)
Eleanor J Molloy1,2,3,4, Mohamed El-Dib5, Janet Soul6
1Paediatrics, Trinity College Dublin, Trinity Research in Childhood Centre (TRICC), Dublin, Ireland. Eleanor.molloy@tcd.ie.
Insights
Improving preterm infant survival necessitates a focus on long-term neurological outcomes. Current neuroprotective strategies are reviewed, highlighting the need for advanced therapies like stem cells and immunomodulation to enhance neurodevelopment.
Area of Science:
- Neonatal care
- Neuroscience
- Perinatal medicine
Background:
- Advances in perinatal and neonatal intensive care have improved preterm infant survival rates.
- The primary challenge now is to mitigate morbidities, particularly adverse neurological outcomes.
- Existing therapies like antenatal steroids show short-term benefits but lack robust evidence for long-term neurodevelopmental impact.
Purpose of the Study:
- To review the multifactorial pathogenesis of preterm brain injury.
- To detail current neuroprotective strategies and emerging treatments for preterm infants.
- To identify essential advancements in neurorestorative therapies and biomarkers.
Main Methods:
- Review of current literature on preterm brain injury and neuroprotection.
- Analysis of existing antenatal and neonatal care practices.
- Discussion of preclinical and ongoing research into novel therapeutic agents.
Main Results:
- Preterm brain injury has complex, multifactorial causes.
- Current neuroprotective measures include antenatal care, seizure management, and NICU care.
- Promising agents like stem cells, immunomodulation, and anti-inflammatory therapies are under investigation.
Conclusions:
- Enhanced neuroprotection and neurorestoration are critical for improving long-term outcomes in preterm infants.
- Optimized neuromonitoring and biomarkers are essential for clinical trial advancement.
- Implementing comprehensive care bundles in the NICU is vital for promoting neuroplasticity and limiting injury.
Abstract:
The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. IMPACT: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.
