AN OVERVIEW OF NEUROPROTECTIVE STRATEGIES IN PRETERM NEONATES

With advances in antenatal and neonatal therapy and care, the survival of preterm neonates, especially extremely immature, has increased. Brain injury occurs significantly more often in preterm neonates compared to full-term neonates, which is associated with a higher risk of neurodevelopmental disorders. Three common and frequent forms of preterm brain injury are intraventricular hemorrhage, white and gray matter injury. There are numerous antenatal, intrapartum and postnatal strategies in order to reduce risk of preterm brain injury and poor neurodevelopmental outcome. First of all, studies showed that antenatal corticosteroid and magnesium sulfate administration in case of threatened preterm delivery has an importance role in reducing the risk for preterm brain injury and neurodevelopmental disabilities. Also, delayed cord clamping and many interventions in early neonatal period, such as maintenance of optimal ventilation and hemodynamic stability, blood glucose monitoring concentration, recognition of neonatal seizures and administration of anti-seizure medications, use of caffeine and optimal nutrition affect the improvement of the neurological development of the preterm neonates. At the end of the 20th century, a special program for the care and assessment of the behavior of neonates, Neonatal Individualized Developmental Care and Assessment Program, was developed, which is used today in many neonatal intensive care units in order to minimize developmental delays of preterm neonates. A number of drugs and interventions whose possible neuroprotective effects are being investigated include mild hypothermia, erythropoietin, melatonin, allopurinol, stem cell therapy, maternal vitamin D supplementation during pregnancy, exosomal-based therapy, et al.