Topical ReviewBrain Injury in the Preterm Infant: New Horizons for Pathogenesis and Prevention
Section snippets
The changing spectrum of white matter injury in contemporary preterm survivors
In prior decades, preterm infants were at much higher risk for destructive brain lesions that resulted in cystic necrotic white matter injury (WMI) and secondary cortical and subcortical gray matter degeneration. Whereas cystic lesions were previously the major form of WMI in preterm survivors, the incidence has markedly declined.24, 25, 26, 27 In several recent series, focal cystic lesions were detected by magnetic resonance imaging (MRI) in fewer than 5% of patients.24, 25, 26, 27, 28, 29
Preterm survivors display impaired cerebral gray matter growth and function
Several large human neuroimaging studies have identified that preterm survivors display significant reductions in the growth of the cerebral cortex and subcortical gray matter structures that include the basal ganglia, thalamus, hippocampus, and cerebellum.50, 89, 90, 91, 92 Reduced cortical growth further manifests as varying degrees of abnormal cortical folding and reduced gyral complexity.93 As children and adults, preterm survivors with normal neurocognitive function nevertheless display
Conclusions
Advances in neonatal care have markedly reduced the overall severity of cerebral injury in infants born prematurely. At the more severe end of the spectrum are preterm survivors with major motor and cognitive disabilities related to destructive lesions where focal or more diffuse loss of neurons and glia occurs. For the majority of more mildly affected children, the burden of chronic disabilities may be related to a primary diffuse cerebral dysmaturation disorder that may respond to
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