Modifiable risk factors for preterm brain injury

The prevalence of preterm birth is increasing globally and it is a leading cause of neurodevelopmental impairment in childhood. Preterm brain injury consists predominantly of: white matter disease, which may be diffuse or cystic and is usually accompanied by grey matter alterations; and haemorrhagic lesions (germinal matrix haemorrhage–intraventricular haemorrhage).The evidence base for neuroprotective strategies has grown in recent years. Antenatal interventions include the use of corticosteroids and magnesium sulphate, and organisation of maternity services so that early postnatal transfer is avoided. Postnatal interventions associated with improved neurological outcome include delayed clamping of the umbilical cord, respiratory management strategies that reduce the incidence of pneumothorax and bronchopulmonary dysplasia, avoidance of hypotension and hypocarbia, feeding practices that promote human milk intake, caffeine therapy, avoidance of early relatively high dose postnatal dexamethasone, and minimising the incidence of postnatal sepsis. In this review, we describe the predominant forms of preterm brain injury in the current era and consider the evidence base for clinical practices designed to reduce brain injury and adverse outcome after preterm birth.