Am J Perinatol 2016; 33(03): 290-296
DOI: 10.1055/s-0035-1571148
Prematurity Special Issue
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perinatal Neuroprotection for Extremely Preterm Infants

Alexis S. Davis
1   Division of Neonatal-Developmental Medicine, Stanford University, Palo Alto, California
,
Victoria K. Berger
2   Division of Maternal-Fetal Medicine, University of California, San Francisco, San Francisco, California
,
Valerie Y. Chock
1   Division of Neonatal-Developmental Medicine, Stanford University, Palo Alto, California
› Author Affiliations
Further Information

Publication History

18 November 2015

24 November 2015

Publication Date:
22 January 2016 (online)

Abstract

The preterm brain is vulnerable to injury through multiple mechanisms, from direct cerebral injury through ischemia and hemorrhage, indirect injury through inflammatory processes, and aberrations in growth and development. While prevention of preterm birth is the best neuroprotective strategy, this is not always possible. This article will review various obstetric and neonatal practices that have been shown to confer a neuroprotective effect on the developing brain.

 
  • References

  • 1 Osterman MJ, Kochanek KD, MacDorman MF, Strobino DM, Guyer B. Annual summary of vital statistics: 2012-2013. Pediatrics 2015; 135 (6) 1115-1125
  • 2 O'Shea TM, Allred EN, Kuban KC , et al; ELGAN Study Investigators. Intraventricular hemorrhage and developmental outcomes at 24 months of age in extremely preterm infants. J Child Neurol 2012; 27 (1) 22-29
  • 3 Tsai AJ, Lasky RE, John SD, Evans PW, Kennedy KA. Predictors of neurodevelopmental outcomes in preterm infants with intraparenchymal hemorrhage. J Perinatol 2014; 34 (5) 399-404
  • 4 Stoll BJ, Hansen NI, Adams-Chapman I , et al; National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292 (19) 2357-2365
  • 5 Kuban KC, O'Shea TM, Allred EN , et al; ELGAN Study Investigators. The breadth and type of systemic inflammation and the risk of adverse neurological outcomes in extremely low gestation newborns. Pediatr Neurol 2015; 52 (1) 42-48
  • 6 Laptook AR, O'Shea TM, Shankaran S, Bhaskar B ; NICHD Neonatal Network. Adverse neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound: prevalence and antecedents. Pediatrics 2005; 115 (3) 673-680
  • 7 Young JM, Powell TL, Morgan BR , et al. Deep grey matter growth predicts neurodevelopmental outcomes in very preterm children. Neuroimage 2015; 111: 360-368
  • 8 Smyser CD, Inder TE, Shimony JS , et al. Longitudinal analysis of neural network development in preterm infants. Cereb Cortex 2010; 20 (12) 2852-2862
  • 9 Ment LR, Vohr B, Oh W , et al. Neurodevelopmental outcome at 36 months' corrected age of preterm infants in the Multicenter Indomethacin Intraventricular Hemorrhage Prevention Trial. Pediatrics 1996; 98 (4, Pt 1) 714-718
  • 10 Shankaran S, Papile L-A, Wright LL , et al. Neurodevelopmental outcome of premature infants after antenatal phenobarbital exposure. Am J Obstet Gynecol 2002; 187 (1) 171-177
  • 11 McCabe ER, Carrino GE, Russell RB, Howse JL. Fighting for the next generation: US prematurity in 2030. Pediatrics 2014; 134 (6) 1193-1199
  • 12 Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50 (4) 515-525
  • 13 Amorim MM, Santos LC, Faúndes A. Corticosteroid therapy for prevention of respiratory distress syndrome in severe preeclampsia. Am J Obstet Gynecol 1999; 180 (5) 1283-1288
  • 14 Garite TJ, Rumney PJ, Briggs GG , et al. A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation. Am J Obstet Gynecol 1992; 166 (2) 646-651
  • 15 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; (3) CD004454
  • 16 NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273 (5) 413-418
  • 17 Wong D, Abdel-Latif M, Kent A ; NICUS Network. Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study. Arch Dis Child Fetal Neonatal Ed 2014; 99 (1) F12-F20
  • 18 American College of Obstetricians and Gynecologists; Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 127: management of preterm labor. Obstet Gynecol 2012; 119 (6) 1308-1317
  • 19 Carlo WA, McDonald SA, Fanaroff AA , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA 2011; 306 (21) 2348-2358
  • 20 Dalziel SR, Lim VK, Lambert A , et al. Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomised controlled trial. BMJ 2005; 331 (7518) 665
  • 21 Sotiriadis A, Tsiami A, Papatheodorou S, Baschat AA, Sarafidis K, Makrydimas G. Neurodevelopmental outcome after a single course of antenatal steroids in children born preterm: a systematic review and meta-analysis. Obstet Gynecol 2015; 125 (6) 1385-1396
  • 22 Garite TJ, Kurtzman J, Maurel K, Clark R ; Obstetrix Collaborative Research Network. Impact of a ‘rescue course’ of antenatal corticosteroids: a multicenter randomized placebo-controlled trial. Am J Obstet Gynecol 2009; 200 (3) 248.e1-248.e9
  • 23 Wapner RJ, Sorokin Y, Thom EA , et al; National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol 2006; 195 (3) 633-642
  • 24 French NP, Hagan R, Evans SF, Godfrey M, Newnham JP. Repeated antenatal corticosteroids: size at birth and subsequent development. Am J Obstet Gynecol 1999; 180 (1, Pt 1) 114-121
  • 25 van de Bor M, Verloove-Vanhorick SP, Brand R, Keirse MJ, Ruys JH. Incidence and prediction of periventricular-intraventricular hemorrhage in very preterm infants. J Perinat Med 1987; 15 (4) 333-339
  • 26 Leviton A, Kuban KC, Pagano M, Brown ER, Krishnamoorthy KS, Allred EN. Maternal toxemia and neonatal germinal matrix hemorrhage in intubated infants less than 1751 g. Obstet Gynecol 1988; 72 (4) 571-576
  • 27 Kuban KC, Leviton A, Pagano M, Fenton T, Strassfeld R, Wolff M. Maternal toxemia is associated with reduced incidence of germinal matrix hemorrhage in premature babies. J Child Neurol 1992; 7 (1) 70-76
  • 28 Crowther CA, Hiller JE, Doyle LW, Haslam RR ; Australasian Collaborative Trial of Magnesium Sulphate (ACTOMg SO4) Collaborative Group. Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 2003; 290 (20) 2669-2676
  • 29 Rouse DJ, Hirtz DG, Thom E , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (9) 895-905
  • 30 Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2009; (1) CD004661
  • 31 Marret S, Doyle LW, Crowther CA, Middleton P. Antenatal magnesium sulphate neuroprotection in the preterm infant. Semin Fetal Neonatal Med 2007; 12 (4) 311-317
  • 32 Stark MJ, Hodyl NA, Andersen CC. Effects of antenatal magnesium sulfate treatment for neonatal neuro-protection on cerebral oxygen kinetics. Pediatr Res 2015; 78 (3) 310-314
  • 33 American College of Obstetricians and Gynecologists Committee on Obstetric Practice; Society for Maternal-Fetal Medicine. Committee Opinion No. 455: magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol 2010; 115 (3) 669-671
  • 34 Carteaux P, Cohen H, Check J , et al. Evaluation and development of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants. Pediatrics 2003; 111 (4, Pt 2) e489-e496
  • 35 Philip AGS, Saigal S. When should we clamp the umbilical cord?. NeoReviews 2004; 5 (4) e142-e154
  • 36 Rabe H, Reynolds G, Diaz-Rossello J. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database Syst Rev 2004; (4) CD003248
  • 37 Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006; 117 (4) 1235-1242
  • 38 Baenziger O, Stolkin F, Keel M , et al. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics 2007; 119 (3) 455-459
  • 39 Ghavam S, Batra D, Mercer J , et al. Effects of placental transfusion in extremely low birthweight infants: meta-analysis of long- and short-term outcomes. Transfusion 2014; 54 (4) 1192-1198
  • 40 Backes CH, Rivera BK, Haque U , et al. Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol 2014; 124 (1) 47-56
  • 41 Sanberg PR, Park DH, Borlongan CV. Stem cell transplants at childbirth. Stem Cell Rev 2010; 6 (1) 27-30
  • 42 Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee Opinion No.543: timing of umbilical cord clamping after birth. Obstet Gynecol 2012; 120 (6) 1522-1526
  • 43 Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr 2015; 169 (7) 631-638
  • 44 Lakshminrusimha S, Van Meurs K. Better timing for cord clamping is after onset of lung aeration. Pediatr Res 2015; 77 (5) 615-617
  • 45 Yao AC, Lind J. Placental transfusion. Am J Dis Child 1974; 127 (1) 128-141
  • 46 Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics 2015; 136 (1) 61-69
  • 47 Krueger MS, Eyal FG, Peevy KJ, Hamm CR, Whitehurst RM, Lewis DF. Delayed cord clamping with and without cord stripping: a prospective randomized trial of preterm neonates. Am J Obstet Gynecol 2015; 212 (3) 394.e1-394.e5
  • 48 Thomas MR, Yoxall CW, Weeks AD, Duley L. Providing newborn resuscitation at the mother's bedside: assessing the safety, usability and acceptability of a mobile trolley. BMC Pediatr 2014; 14: 135
  • 49 Fuchs H, Lindner W, Buschko A, Almazam M, Hummler HD, Schmid MB. Brain oxygenation monitoring during neonatal resuscitation of very low birth weight infants. J Perinatol 2012; 32 (5) 356-362
  • 50 Binder C, Urlesberger B, Avian A, Pocivalnik M, Müller W, Pichler G. Cerebral and peripheral regional oxygen saturation during postnatal transition in preterm neonates. J Pediatr 2013; 163 (2) 394-399
  • 51 Fuchs H, Lindner W, Buschko A, Trischberger T, Schmid M, Hummler HD. Cerebral oxygenation in very low birth weight infants supported with sustained lung inflations after birth. Pediatr Res 2011; 70 (2) 176-180
  • 52 Baik N, Urlesberger B, Schwaberger B, Schmölzer GM, Avian A, Pichler G. Cerebral haemorrhage in preterm neonates: does cerebral regional oxygen saturation during the immediate transition matter?. Arch Dis Child Fetal Neonatal Ed 2015; 100 (5) F422-F427
  • 53 Verhagen EA, Van Braeckel KNJA, van der Veere CN , et al. Cerebral oxygenation is associated with neurodevelopmental outcome of preterm children at age 2 to 3 years. Dev Med Child Neurol 2015; 57 (5) 449-455
  • 54 Schneider A, Minnich B, Hofstätter E, Weisser C, Hattinger-Jürgenssen E, Wald M. Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants. Acta Paediatr 2014; 103 (9) 934-938
  • 55 McLendon D, Check J, Carteaux P , et al. Implementation of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants. Pediatrics 2003; 111 (4, Pt 2) e497-e503
  • 56 Bada HS, Hajjar W, Chua C, Sumner DS. Noninvasive diagnosis of neonatal asphyxia and intraventricular hemorrhage by Doppler ultrasound. J Pediatr 1979; 95 (5, Pt 1) 775-779
  • 57 Emery JR, Peabody JL. Head position affects intracranial pressure in newborn infants. J Pediatr 1983; 103 (6) 950-953
  • 58 Pellicer A, Gayá F, Madero R, Quero J, Cabañas F. Noninvasive continuous monitoring of the effects of head position on brain hemodynamics in ventilated infants. Pediatrics 2002; 109 (3) 434-440
  • 59 Aschner JL, Poland RL. Sodium bicarbonate: basically useless therapy. Pediatrics 2008; 122 (4) 831-835
  • 60 Ment LR, Oh W, Ehrenkranz RA , et al. Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial. Pediatrics 1994; 93 (4) 543-550
  • 61 Schmidt B, Davis P, Moddemann D , et al; Trial of Indomethacin Prophylaxis in Preterms Investigators. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med 2001; 344 (26) 1966-1972
  • 62 Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2010; (7) CD000174
  • 63 Yanowitz TD, Yao AC, Werner JC, Pettigrew KD, Oh W, Stonestreet BS. Effects of prophylactic low-dose indomethacin on hemodynamics in very low birth weight infants. J Pediatr 1998; 132 (1) 28-34
  • 64 Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 2006; 117 (4) 1113-1121
  • 65 Oh W, Poindexter BB, Perritt R , et al; Neonatal Research Network. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr 2005; 147 (6) 786-790
  • 66 Osborn DA, Evans N, Kluckow M. Hemodynamic and antecedent risk factors of early and late periventricular/intraventricular hemorrhage in premature infants. Pediatrics 2003; 112 (1, Pt 1) 33-39
  • 67 Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A ; Trial of Indomethacin Prophylaxis in Preterms Investigators. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr 2007; 150 (3) 229-234 , 234.e1
  • 68 Luque MJ, Tapia JL, Villarroel L , et al; Neocosur Neonatal Network. A risk prediction model for severe intraventricular hemorrhage in very low birth weight infants and the effect of prophylactic indomethacin. J Perinatol 2014; 34 (1) 43-48
  • 69 Kelleher J, Salas AA, Bhat R , et al; GDB Subcommittee, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants. Pediatrics 2014; 134 (5) e1369-e1377
  • 70 Henderson-Smart DJ, Steer P. Methylxanthine treatment for apnea in preterm infants. Cochrane Database Syst Rev 2001; (3) CD000140
  • 71 Schmidt B, Roberts RS, Davis P , et al; Caffeine for Apnea of Prematurity Trial Group. Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med 2007; 357 (19) 1893-1902
  • 72 Doyle LW, Cheong J, Hunt RW , et al. Caffeine and brain development in very preterm infants. Ann Neurol 2010; 68 (5) 734-742
  • 73 Mohammed S, Nour I, Shabaan AE, Shouman B, Abdel-Hady H, Nasef N. High versus low-dose caffeine for apnea of prematurity: a randomized controlled trial. Eur J Pediatr 2015; 174 (7) 949-956
  • 74 Ohls RK, Ehrenkranz RA, Das A , et al; National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental outcome and growth at 18 to 22 months' corrected age in extremely low birth weight infants treated with early erythropoietin and iron. Pediatrics 2004; 114 (5) 1287-1291
  • 75 Bierer R, Peceny MC, Hartenberger CH, Ohls RK. Erythropoietin concentrations and neurodevelopmental outcome in preterm infants. Pediatrics 2006; 118 (3) e635-e640
  • 76 Neubauer AP, Voss W, Wachtendorf M, Jungmann T. Erythropoietin improves neurodevelopmental outcome of extremely preterm infants. Ann Neurol 2010; 67 (5) 657-666
  • 77 McAdams RM, McPherson RJ, Mayock DE, Juul SE. Outcomes of extremely low birth weight infants given early high-dose erythropoietin. J Perinatol 2013; 33 (3) 226-230
  • 78 Ohls RK, Kamath-Rayne BD, Christensen RD , et al. Cognitive outcomes of preterm infants randomized to darbepoetin, erythropoietin, or placebo. Pediatrics 2014; 133 (6) 1023-1030
  • 79 O'Gorman RL, Bucher HU, Held U, Koller BM, Hüppi PS, Hagmann CF ; Swiss EPO Neuroprotection Trial Group. Tract-based spatial statistics to assess the neuroprotective effect of early erythropoietin on white matter development in preterm infants. Brain 2015; 138 (Pt 2) 388-397
  • 80 Leuchter RH, Gui L, Poncet A , et al. Association between early administration of high-dose erythropoietin in preterm infants and brain MRI abnormality at term-equivalent age. JAMA 2014; 312 (8) 817-824
  • 81 Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2014; 4 (4) CD004863
  • 82 Fauchère JC, Koller BM, Tschopp A, Dame C, Ruegger C, Bucher HU ; Swiss Erythropoietin Neuroprotection Trial Group. Safety of early high-dose recombinant erythropoietin for neuroprotection in very preterm infants. J Pediatr 2015; 167 (1) 52-7.e1, 3
  • 83 Schulman J, Stricof R, Stevens TP , et al; New York State Regional Perinatal Care Centers. Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011; 127 (3) 436-444
  • 84 Katheria A, Rich W, Finer N. Development of a strategic process using checklists to facilitate team preparation and improve communication during neonatal resuscitation. Resuscitation 2013; 84 (11) 1552-1557