Brain injury in preterm infants

Abstract

Perinatal care advances over the past twenty years have helped to diminish the mortality and severe neurological morbidity of extremely and very preterm infants. However, motor and/or cognitive disabilities associated with mild-to-moderate white and grey matter injury are frequently present in this population. The major neuropathological substrate of preterm brain injury is encephalopathy of prematurity which characterizes the multifaceted white and grey matter lesions, and reflects a combination of destructive and dysmaturational effects. It can be associated with haemorrhages, notably in germinal matrix and cerebellum and with focal micro-or macroinfarcts. Clinical signs of brain injury are often subtle or even absent, therefore several new non-invasive methods are used to identify and estimate central nervous system dysfunction. They provide insight into hemodynamics, electrical activity and brain structure. Knowing and understanding the causes and the mechanisms of brain injury yield to a number of more or less successful neuroprotective approaches that reduce the negative influences on the developing brain. Since brain injury and consequently its long term neurodevelopmental outcome remains the most important complication of the premature birth, a regular and comprehensive follow-up of motor, cognitive and behavioral development of these children is essential, as it provides early detection of potential delays and intervention.