Preterm birth and the role of neuroprotection

Abstract

Preterm birth remains a common complication of pregnancy and causes substantial neonatal morbidity and mortality. As improvements in the care of preterm neonates have outpaced efforts to prevent preterm birth, the numbers of survivors with neurologic sequelae that affect quality of life have increased. The main strategies to reduce the impact of neurologic complications of prematurity include prevention of preterm birth and protection of the developing fetal brain through antenatal administration of drugs. These strategies rely on a basic understanding of the intertwined pathophysiology of spontaneous preterm labor and perinatal brain injury, which will be reviewed here. The review will outline current methods for the prevention of prematurity and neuroprotection. The use of magnesium sulfate as a neuroprotective compound will be discussed, including concerns over its association with increased pediatric mortality and abnormalities in bone density.

Protecting the premature brain: current evidence-based strategies for minimising perinatal brain injury in preterm infants

“…Subsequently, a decrease in the incidence of CP was presented34 and animal models and clinical trials have since corroborated these findings 19. MgSO 4 acts as a non-competitive inhibitor at N-methyl-D-aspartate channels, blocking excess glutamate release, reducing excitotoxicity and consequently oligodendroglial progenitor cell death,35 as well as modulating the effects of proinflammatory cytokines which are known to correlate with neurological outcome 36. In addition, due to MgSO 4 's vasoactive properties, further benefit may result from stabilisation of blood pressure37 and cerebral arterial perfusion 38…”

“…Cumulative high doses of MgSO 4 (>50 g) are associated with IVH and increased mortality51 52 making clear guidance on dosing crucial. Developing this is impeded by the variability in evidence 19 35 53. Differing dosing schedules, trial inclusion criteria and mixed intent (obstetric vs fetal neuroprotective) complicate interpretation 53.…”

Re: Magnesium sulphate, chorioamnionitis, and neurodevelopment after preterm birth

“…There are many subtle neurological impairments related to prematurity such as sensory neural hearing loss, visual impairments, and attention, cognitive and academic impairments. So the effects of magnesium, sulphate may be underestimated and this needs to be considered when considering the overall effect . It is clear that there remain gaps in our knowledge on preterm labour, neurodevelopmental impairments and the effects of magnesium sulphate.…”

Urinary Levels of IL-1β and GDNF in Preterm Neonates as Potential Biomarkers of Motor Development: A Prospective Study

“…The resulting balance between injury-associated inflammation and protective mechanisms, including the production of neurotrophic factors [27], is critical for the final development of the central nervous system (CNS) [28]. In this context, we hypothesize that inflammation is associated with motor development in preterm infants.…”