Preterm Brain Injury, Antenatal Triggers, and Therapeutics: Timing Is Key

Abstract

With a worldwide incidence of 15 million cases, preterm birth is a major contributor to neonatal mortality and morbidity, and concomitant social and economic burden Preterm infants are predisposed to life-long neurological disorders due to the immaturity of the brain. The risks are inversely proportional to maturity at birth. In the majority of extremely preterm infants (<28 weeks’ gestation), perinatal brain injury is associated with exposure to multiple inflammatory perinatal triggers that include antenatal infection (i.e., chorioamnionitis), hypoxia-ischemia, and various postnatal injurious triggers (i.e., oxidative stress, sepsis, mechanical ventilation, hemodynamic instability). These perinatal insults cause a self-perpetuating cascade of peripheral and cerebral inflammation that plays a critical role in the etiology of diffuse white and grey matter injuries that underlies a spectrum of connectivity deficits in survivors from extremely preterm birth. This review focuses on chorioamnionitis and hypoxia-ischemia, which are two important antenatal risk factors for preterm brain injury, and highlights the latest insights on its pathophysiology, potential treatment, and future perspectives to narrow the translational gap between preclinical research and clinical applications.

Potential Benefits of Bovine Colostrum in Pediatric Nutrition and Health

“…Such prenatal insults are associated with infections just after birth (early onset sepsis, EOS) and altered immune system development with a range of adverse short- and longer-term outcomes across many organs (e.g., NEC, BPD, and IVH) [ 245 ]. The health consequences of fetal inflammation for preterm infants are highly dependent on the type, length and level of fetal infection-induced inflammation, from inducing a precocious (potentially beneficial) immune maturation, to adverse immune defects with subsequent widespread inflammatory insults [ 246 , 247 ]. No studies are available in infants but in theory, BC supplementation may ameliorate the postnatal consequences of fetal inflammation by better control of bacterial colonization after birth and modulation of local and systemic immune responses.…”

The Role of Extracellular Vesicles in the Developing Brain: Current Perspective and Promising Source of Biomarkers and Therapy for Perinatal Brain Injury

“…Clinical presentation of injuries, as well as timing of the initial onset is often unclear and difficult to determine (Ophelders et al, 2020). This is especially apparent in the case of HI injuries, since observed latency for first appearance of seizures can vary from minutes to days following birth (Naeye and Lin, 2001).…”

ID-Seg: An Accurate and Reliable Infant Deep learning Segmentation Framework for Limbic Structures

“…First, the dHCP segmentation pipeline was developed based on 20 manually segmented infant brain scans; however, 15 of these were from infants born prematurely. Samples used in our work are born from full-term infants, and numerous previous studies have shown significant structural brain differences in pre-relative to full-term infants (Ment & Vohr, 2008;Ophelders et al, 2020). Second, MRI scans in our work were collected from multiple vendors, including GE, Siemens, and Philips, allowing ID-Seg to learn and adapt to the idiosyncratic features of specific MRI vendors.…”