title: Destruction and reconstruction: hypoxia and the developing brain.
abstract: Preterm infants have a high rate of neurodevelopmental handicap. Recent imaging studies have revealed that adverse outcomes are strongly associated with reduced brain growth and neural complexity in later life. Increasing data suggest that these chronic deficits primarily reflect acute neuronal and glial injury sustained during adverse in utero events, such as exposure to severe hypoxia-ischemia and inflammation. In the present review we examine recent evidence that this chronic impairment is partly due to upregulation of physiological apoptosis, related to input deprivation, and output isolation secondary to acute white and gray matter damage and axonal injury. However, progenitor cells in the subventricular zone (SVZ) are also vulnerable to injury, and loss of part of this critical population likely further compromises brain development. Based on these concepts the impact of proposed interventions such as induced hypothermia and endogenous growth factors are likely to be complex, but potentially offer focused ways of improving the outcomes of premature birth.
authors.affiliation: Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Barrett
authors.forename: Laura
authors.initials: L
authors.lastname: Bennet
authors.forename: Joanne
authors.initials: J
authors.lastname: Davidson
authors.forename: Justin M
authors.initials: JM
authors.lastname: Dean
authors.forename: Sherly
authors.initials: S
authors.lastname: George
authors.forename: Bright S
authors.initials: BS
authors.lastname: Emerald
authors.forename: Alistair Jan
authors.initials: AJ
authors.lastname: Gunn
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D017209:Apoptosis; D001921:Brain / Q000196:embryology* / Q000254:growth & development* / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000209:etiology / Q000473:pathology; D020833:Diffuse Axonal Injury / Q000473:pathology; D047109:Fetal Development; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology*; D020925:Hypoxia-Ischemia, Brain / Q000503:physiopathology; D007231:Infant, Newborn; D007234:Infant, Premature; D008954:Models, Biological