Perinatal Neuroprotection in Preterm Birth

Preterm birth is one of the main causes of perinatal morbidity and mortality. The rate of grade III and IV cerebral hemorrhages in infants with a birth weight of less than 1500 g in Germany in 2022 was 2.97% and the periventricular leukomalacia rate was 1.07%. In addition to these severe forms of brain damage which are visible on sonography, recent MRI studies carried out at the calculated due date of affected children also showed diffuse white and grey matter injuries, especially of the basal ganglia and the cerebellum, indicating impaired brain development and function. To offer these children the best possible start in life it is essential that they are cared for in a level I perinatal center right from the start. In addition, a number of perinatal measures are available which may significantly improve the neuronal development in preterm infants. They include the use of antenatal corticosteroids and magnesium as well as deferred cutting of the umbilical cord. Recent studies have shown that in contrast to term-born infants, hypothermia treatment is unsuitable for neuroprotection in premature babies. As secondary and tertiary cell damage may occur days or even weeks after the primary insult due to persistent inflammation and the lack of trophic stimulation, in addition to providing premature infants with the best possible initial care, it is also necessary to optimize subsequent care in the intensive care unit in terms of providing a neuronal-positive stimulating environment. Breastfeeding and supply of breast milk are particularly important in this context.