Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle.
Roopali SoniCharlotte TscherningNicola J RobertsonPublished in: Archives of disease in childhood. Fetal and neonatal edition (2021)
Advances in neonatal-perinatal medicine have resulted in increased survival at lower gestations. Although the incidence of germinal matrix haemorrhage-intraventricular haemorrhage and cystic periventricular leucomalacia is reducing, a new phenotype of preterm brain injury has emerged consisting of a combination of destructive and dysmaturational effects. Consequently, severe neurological disability is reported at a lower rate than previously, but the overall morbidity associated with premature birth continues to present a large global burden and contributes significantly to increased financial costs to health systems and families. In this review, we examine the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. We review common morbidities associated with premature birth today. Although drug-based and cell-based neuroprotective therapies for the preterm brain are under intense study, we outline basic, sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes for this population and need to be considered part of the future neuroprotection care bundle.
Keyphrases
- brain injury
- preterm birth
- cerebral ischemia
- healthcare
- gestational age
- low birth weight
- palliative care
- subarachnoid hemorrhage
- quality improvement
- affordable care act
- pain management
- multiple sclerosis
- type diabetes
- single cell
- preterm infants
- pregnant women
- white matter
- stem cells
- risk factors
- skeletal muscle
- young adults
- emergency department
- congenital heart disease
- adipose tissue
- mesenchymal stem cells
- functional connectivity
- childhood cancer
- glycemic control