Global prevalence of long-term neurodevelopmental impairment following extremely preterm birth: a systematic literature review

Sarda, Sujata P.; Sarri, Grammati; Siffel, Csaba

doi:10.1177/03000605211028026

Cited by 27 publications

(21 citation statements)

References 92 publications

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“…Brain injury in preterm infants is multifactorial, but rates of HIE in preterm infants are higher than at term ( 3 ). Preterm birth is associated with about one-third of all cases of cerebral palsy ( 4 ), and high rates of motor deficits, cognitive and language delay, and behavioral problems ( 5 ). Therapeutic hypothermia is standard care for term infants with moderate-severe HIE to reduce death and disability.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

et al. 2022

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Perinatal hypoxia-ischemia (HI) is still a significant contributor to mortality and adverse neurodevelopmental outcomes in term and preterm infants. HI brain injury evolves over hours to days, and involves complex interactions between the endogenous protective and pathological processes. Understanding the timing of evolution of injury is vital to guide treatment. Post-HI recovery is associated with a typical neurophysiological profile, with stereotypic changes in cerebral perfusion and oxygenation. After the initial recovery, there is a delayed, prolonged reduction in cerebral perfusion related to metabolic suppression, followed by secondary deterioration with hyperperfusion and increased cerebral oxygenation, associated with altered neurovascular coupling and impaired cerebral autoregulation. These changes in cerebral perfusion are associated with the stages of evolution of injury and injury severity. Further, iatrogenic factors can also affect cerebral oxygenation during the early period of deranged metabolism, and improving clinical management may improve neuroprotection. We will review recent evidence that changes in cerebral oxygenation and metabolism after HI may be useful biomarkers of prognosis.

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Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

et al. 2022

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“…In the neonatal intensive care unit (NICU), very preterm infants represent a particularly vulnerable patient population. They are highly susceptible to postnatal complications such as intraventricular hemorrhage (IVH), which increases their risk of mortality and is a major cause of morbidity . Despite improved diagnostic capabilities and the increasing availability of long-term data on the outcome of very preterm infants, it remains a complex task for neonatologists to derive predictions for the short-term survival and long-term neurodevelopmental outcome of an individual infant from the results of general population-based research and to communicate these to parents .…”

Section: Introductionmentioning

confidence: 99%

Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants

Forth,

Hammerle,

König

et al. 2024

JAMA Netw Open

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ImportanceIn the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents.ObjectiveTo examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication.Design, Setting, and ParticipantsThis crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022.InterventionsAlternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing).Main Outcomes and MeasuresThe primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates.ResultsOf 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P &lt; .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, −0.34; −1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, −0.55; 95% CI, −1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P &lt; .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16).Conclusions and RelevanceWhen given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment.Trial RegistrationGerman Clinical Trials Register (DRKS): DRKS00024466

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“…Preterm birth is highly associated with mortality and life-long neurodevelopmental disabilities, 1 and there are no established neuroprotection or neuro-repair interventions. Antenatal and/or perinatal hypoxia-ischaemia (HI) remains a major contributor in the multifactorial aetiology of preterm brain damage.…”

Section: Introductionmentioning

confidence: 99%

Alpha-adrenergic receptor activation after fetal hypoxia-ischaemia suppresses transient epileptiform activity and limits loss of oligodendrocytes and hippocampal neurons

Dhillon

Pedersen

Lear

et al. 2023

J Cereb Blood Flow Metab

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Exposure to hypoxic-ischaemia (HI) is consistently followed by a delayed fall in cerebral perfusion. In preterm fetal sheep this is associated with impaired cerebral oxygenation, consistent with mismatch between perfusion and metabolism. In the present study we tested the hypothesis that alpha-adrenergic inhibition after HI would improve cerebral perfusion, and so attenuate mismatch and reduce neural injury. Chronically instrumented preterm (0.7 gestation) fetal sheep received sham-HI (n = 10) or HI induced by complete umbilical cord occlusion for 25 minutes. From 15 minutes to 8 hours after HI, fetuses received either an intravenous infusion of a non-selective alpha-adrenergic antagonist, phentolamine (10 mg bolus, 10 mg/h infusion, n = 10), or saline (n = 10). Fetal brains were processed for histology 72 hours post-HI. Phentolamine infusion was associated with increased epileptiform transient activity and a greater fall in cerebral oxygenation in the early post-HI recovery phase. Histologically, phentolamine was associated with greater loss of oligodendrocytes and hippocampal neurons. In summary, contrary to our hypothesis, alpha-adrenergic inhibition increased epileptiform transient activity with an exaggerated fall in cerebral oxygenation, and increased neural injury, suggesting that alpha-adrenergic receptor activation after HI is an important endogenous neuroprotective mechanism.

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Global prevalence of long-term neurodevelopmental impairment following extremely preterm birth: a systematic literature review

Cited by 27 publications

References 92 publications

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

Cerebral Oxygenation and Metabolism After Hypoxia-Ischemia

Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants

Alpha-adrenergic receptor activation after fetal hypoxia-ischaemia suppresses transient epileptiform activity and limits loss of oligodendrocytes and hippocampal neurons

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