Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)

Eleanor J. Molloy; Mohamed El-Dib; Janet Soul; Sandra Juul; Alistair J. Gunn; Manon Bender; Fernando Gonzalez; Cynthia Bearer; Yvonne Wu; Nicola J. Robertson; Mike Cotton; Aoife Branagan; Tim Hurley; Sidhartha Tan; Abbot Laptook; Topun Austin; Khorshid Mohammad; Elizabeth Rogers; Karen Luyt; Pia Wintermark; Sonia Lomeli Bonifacio; Sonia Lomeli Bonifacio; Pia Wintermark; Hany Aly; Vann Chau; Hannah Glass; Monica Lemmon; Courtney Wusthoff; Gabrielle deVeber; Andrea Pardo; Melisa Carrasco; James Boardman; Dawn Gano; Eric Peeples

doi:10.1038/s41390-023-02895-6

Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)

Eleanor J. Molloy^*, Mohamed El-Dib, Janet Soul, Sandra Juul, Alistair J. Gunn, Manon Bender, Fernando Gonzalez, Cynthia Bearer, Yvonne Wu, Nicola J. Robertson, Mike Cotton, Aoife Branagan, Tim Hurley, Sidhartha Tan, Abbot Laptook, Topun Austin, Khorshid Mohammad, Elizabeth Rogers, Karen Luyt, Pia WintermarkSonia Lomeli Bonifacio, Sonia Lomeli Bonifacio, Pia Wintermark, Hany Aly, Vann Chau, Hannah Glass, Monica Lemmon, Courtney Wusthoff, Gabrielle deVeber, Andrea Pardo, Melisa Carrasco, James Boardman, Dawn Gano, Eric Peeples

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

Abstract: The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. Impact: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.

Original language	English
Pages (from-to)	1224-1236
Number of pages	13
Journal	Pediatric Research
Volume	95
Issue number	5
DOIs	https://doi.org/10.1038/s41390-023-02895-6
Publication status	Published - Apr 2024

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Molloy, E. J., El-Dib, M., Soul, J., Juul, S., Gunn, A. J., Bender, M., Gonzalez, F., Bearer, C., Wu, Y., Robertson, N. J., Cotton, M., Branagan, A., Hurley, T., Tan, S., Laptook, A., Austin, T., Mohammad, K., Rogers, E., Luyt, K., ... Peeples, E. (2024). Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series). Pediatric Research, 95(5), 1224-1236. https://doi.org/10.1038/s41390-023-02895-6

@article{c8113fd03a704b69b3e56aba9a3c01c3,

title = "Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)",

abstract = "Abstract: The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. Impact: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.",

author = "Molloy, {Eleanor J.} and Mohamed El-Dib and Janet Soul and Sandra Juul and Gunn, {Alistair J.} and Manon Bender and Fernando Gonzalez and Cynthia Bearer and Yvonne Wu and Robertson, {Nicola J.} and Mike Cotton and Aoife Branagan and Tim Hurley and Sidhartha Tan and Abbot Laptook and Topun Austin and Khorshid Mohammad and Elizabeth Rogers and Karen Luyt and Pia Wintermark and Bonifacio, {Sonia Lomeli} and Bonifacio, {Sonia Lomeli} and Pia Wintermark and Hany Aly and Vann Chau and Hannah Glass and Monica Lemmon and Courtney Wusthoff and Gabrielle deVeber and Andrea Pardo and Melisa Carrasco and James Boardman and Dawn Gano and Eric Peeples",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2024",

month = apr,

doi = "10.1038/s41390-023-02895-6",

language = "English",

volume = "95",

pages = "1224--1236",

journal = "Pediatric Research",

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Molloy, EJ, El-Dib, M, Soul, J, Juul, S, Gunn, AJ, Bender, M, Gonzalez, F, Bearer, C, Wu, Y, Robertson, NJ, Cotton, M, Branagan, A, Hurley, T, Tan, S, Laptook, A, Austin, T, Mohammad, K, Rogers, E, Luyt, K, Wintermark, P, Bonifacio, SL, Bonifacio, SL, Wintermark, P, Aly, H, Chau, V, Glass, H, Lemmon, M, Wusthoff, C, deVeber, G, Pardo, A, Carrasco, M, Boardman, J, Gano, D & Peeples, E 2024, 'Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)', Pediatric Research, vol. 95, no. 5, pp. 1224-1236. https://doi.org/10.1038/s41390-023-02895-6

TY - JOUR

T1 - Neuroprotective therapies in the NICU in preterm infants

T2 - present and future (Neonatal Neurocritical Care Series)

AU - Molloy, Eleanor J.

AU - El-Dib, Mohamed

AU - Soul, Janet

AU - Juul, Sandra

AU - Gunn, Alistair J.

AU - Bender, Manon

AU - Gonzalez, Fernando

AU - Bearer, Cynthia

AU - Wu, Yvonne

AU - Robertson, Nicola J.

AU - Cotton, Mike

AU - Branagan, Aoife

AU - Hurley, Tim

AU - Tan, Sidhartha

AU - Laptook, Abbot

AU - Austin, Topun

AU - Mohammad, Khorshid

AU - Rogers, Elizabeth

AU - Luyt, Karen

AU - Wintermark, Pia

AU - Bonifacio, Sonia Lomeli

AU - Wintermark, Pia

AU - Aly, Hany

AU - Chau, Vann

AU - Glass, Hannah

AU - Lemmon, Monica

AU - Wusthoff, Courtney

AU - deVeber, Gabrielle

AU - Pardo, Andrea

AU - Carrasco, Melisa

AU - Boardman, James

AU - Gano, Dawn

AU - Peeples, Eric

PY - 2024/4

Y1 - 2024/4

N2 - Abstract: The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. Impact: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.

AB - Abstract: The survival of preterm infants has steadily improved thanks to advances in perinatal and neonatal intensive clinical care. The focus is now on finding ways to improve morbidities, especially neurological outcomes. Although antenatal steroids and magnesium for preterm infants have become routine therapies, studies have mainly demonstrated short-term benefits for antenatal steroid therapy but limited evidence for impact on long-term neurodevelopmental outcomes. Further advances in neuroprotective and neurorestorative therapies, improved neuromonitoring modalities to optimize recruitment in trials, and improved biomarkers to assess the response to treatment are essential. Among the most promising agents, multipotential stem cells, immunomodulation, and anti-inflammatory therapies can improve neural outcomes in preclinical studies and are the subject of considerable ongoing research. In the meantime, bundles of care protecting and nurturing the brain in the neonatal intensive care unit and beyond should be widely implemented in an effort to limit injury and promote neuroplasticity. Impact: With improved survival of preterm infants due to improved antenatal and neonatal care, our focus must now be to improve long-term neurological and neurodevelopmental outcomes. This review details the multifactorial pathogenesis of preterm brain injury and neuroprotective strategies in use at present, including antenatal care, seizure management and non-pharmacological NICU care. We discuss treatment strategies that are being evaluated as potential interventions to improve the neurodevelopmental outcomes of infants born prematurely.

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U2 - 10.1038/s41390-023-02895-6

DO - 10.1038/s41390-023-02895-6

M3 - Review article

C2 - 38114609

AN - SCOPUS:85180208531

SN - 0031-3998

VL - 95

SP - 1224

EP - 1236

JO - Pediatric Research

JF - Pediatric Research

IS - 5

ER -

Neuroprotective therapies in the NICU in preterm infants: present and future (Neonatal Neurocritical Care Series)

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