Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)

Eleanor J Molloy*, Mohamed El-Dib, Janet Soul, Sandra Juul, Alistair J Gunn, Manon Bender, Fernando Gonzalez, Cynthia Bearer, Yvonne Wu, Nicola J Robertson, Mike Cotton, Aoife Branagan, Tim Hurley, Sidhartha Tan, Abbot Laptook, Topun Austin, Khorshid Mohammad, Elizabeth Rogers, Karen Luyt, Pia WintermarkSonia Lomeli Bonifacio, Newborn Brain Society Guidelines and Publications Committee

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract / Description of output

The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. IMPACT: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.

Original languageEnglish
JournalPediatric Research
Early online date19 Dec 2023
DOIs
Publication statusE-pub ahead of print - 19 Dec 2023

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