title: Impact of common treatments given in the perinatal period on the developing brain.
abstract: BACKGROUND
  Over the last decades, considerable progress has been made in the perinatal management of high-risk preterm neonates, changing the landscape of pathological conditions associated with neurological impairments. Major focal destructive lesions are now less common, and the predominant neuropathological lesion is diffuse white-matter damage in the most immature infants. Similarly, over the last few years, we have observed a trend towards a decrease in neurological impairment in the absence of treatments specifically aimed at neuroprotection.
  
  
  OBJECTIVE
  We examined whether recent changes in treatment strategies in perinatal care during the perinatal period could have had an indirect beneficial impact on the occurrence of brain lesions and their consequences.
  
  
  METHODS
  Thus, we reviewed the effects of the most common treatments administered during the perinatal period to the mother or to very preterm infants on brain damage and neurocognitive follow-up.
  
  
  RESULTS
  Antenatal steroids and exogenous surfactant are the two main treatments capable of leading to neuroprotection in very preterm infants. Randomized controlled trials are currently investigating the effects of inhaled nitric oxide and erythropoietin, while antenatal magnesium sulphate and caffeine are also likely to provide some neuroprotection, but this needs to be further investigated. Finally, other common treatments against pain, haemodynamic failure and patent ductus arteriosus have conflicting or no effects on the developing brain.
  
  
  CONCLUSIONS
  While specific neuroprotective drugs are still awaited, recent advances in perinatal care have been associated with an unexpected but significant decrease in the incidence of both severe brain lesions and neurological impairment.
authors.affiliation: Neonatal Intensive Care Unit (ICU), CHRU de Tours, Tours, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Favrais
authors.forename: Pierre
authors.initials: P
authors.lastname: Tourneux
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lopez
authors.forename: Xavier
authors.initials: X
authors.lastname: Durrmeyer
authors.forename: Géraldine
authors.initials: G
authors.lastname: Gascoin
authors.forename: Duksha
authors.initials: D
authors.lastname: Ramful
authors.forename: Elodie
authors.initials: E
authors.lastname: Zana-Taieb
authors.forename: Olivier
authors.initials: O
authors.lastname: Baud
mesh_terms: D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000818:Animals; D000890:Anti-Infective Agents / Q000494:pharmacology; D001921:Brain / Q000187:drug effects* / Q000196:embryology / Q000254:growth & development; D003071:Cognition / Q000187:drug effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development; D008278:Magnesium Sulfate / Q000494:pharmacology; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology / Q000523:psychology; D055553:Prescription Drugs / Q000494:pharmacology*
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D055553:Prescription Drugs; D008278:Magnesium Sulfate