Brain injury in the premature infant. Neuropathology, clinical aspects, pathogenesis, and prevention.
There are two principal lesions that underlie brain injury and the neurologic manifestations in the premature infant: periventricular hemorrhagic infarction and periventricular leukomalacia. Both of these lesions may be potentially preventable: periventricular hemorrhagic infarction by preventing germinal matrix-IVH, and periventricular leukomalacia by detecting impaired cerebrovascular regulation with near-infrared spectroscopy, preventing the impaired cerebral blood flow and interrupting the cascade to oligodendroglial cell death, perhaps by such agents as free-radical scavengers. Prenatal magnesium sulfate also may be valuable. The greatest progress toward prevention has been made regarding periventricular hemorrhagic infarction, but the advent of new technologies, especially near-infrared spectroscopy, and of new insights into the cellular basis for oligodendroglial vulnerability provide hope for prevention of periventricular leukomalacia.
Volpe
J J
JJ
Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.
D001927:Brain Diseases / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D016923:Cell Death; D002543:Cerebral Hemorrhage / Q000150:complications / Q000473:pathology / Q000517:prevention & control; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology / Q000517:prevention & control; D002560:Cerebrovascular Circulation; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D007969:Leukomalacia, Periventricular / Q000150:complications / Q000473:pathology / Q000517:prevention & control; D008278:Magnesium Sulfate / Q000627:therapeutic use; D009836:Oligodendroglia / Q000473:pathology; D019265:Spectroscopy, Near-Infrared; D015149:Tocolytic Agents / Q000627:therapeutic use
D016166:Free Radical Scavengers; D015149:Tocolytic Agents; D008278:Magnesium Sulfate