Encephalopathy of Prematurity

Abstract

Encephalopathy of prematurity (EOP) is a histologically defined condition common in preterm infants characterized by cerebral white matter injury/periventricular leukomalacia with a variety of associated neuronal/axonal deficits. The fetal/maternal and neonatal conditions leading to EOP are those typically associated with cerebral ischemia and systemic infection/inflammation. Recognizing the neurologic correlates of EOP for infants in the NICU is challenging because the clinical manifestations are not particularly distinctive. As a result, the diagnosis of EOP relies heavily on EEG and neuroimaging studies, mainly head ultrasound and EEG. Infants with EOP have a high incidence of chronic neurodevelopmental impairment in a variety of areas—motor coordination, visual function, cognitive function, language ability, socialization, and behavior. These impairments can be predicted, to some degree, with neuroimaging findings and their known neuropathologic correlates. Clinical management of preterm infants during the neonatal period may influence outcome, and relevant elements include administration of steroids prior to delivery as well as management of oxygen levels, carbon dioxide levels, blood pressure, glucose levels, seizures, and patent ductus arteriosus. Neuroprotective strategies that might mitigate the effects of EOP are currently under evaluation. Among these are erythropoietins, epidermal growth factor, insulin-like growth factor, and stem cell administration. Finally, the environment of the NICU itself is important for optimizing neurodevelopmental outcomes. Factors such as auditory exposure, visual exposure, and human contact should be taken into account in NICU management.