Department of Pediatrics, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands.
School for Oncology and Developmental Biology (GROW), Maastricht University, 6229 ER Maastricht, The Netherlands.
Cells. 2020 Aug 10;9(8):1871. doi: 10.3390/cells9081871.
With a worldwide incidence of 15 million cases, preterm birth is a major contributor to neonatal mortality and morbidity, and concomitant social and economic burden Preterm infants are predisposed to life-long neurological disorders due to the immaturity of the brain. The risks are inversely proportional to maturity at birth. In the majority of extremely preterm infants (<28 weeks' gestation), perinatal brain injury is associated with exposure to multiple inflammatory perinatal triggers that include antenatal infection (i.e., chorioamnionitis), hypoxia-ischemia, and various postnatal injurious triggers (i.e., oxidative stress, sepsis, mechanical ventilation, hemodynamic instability). These perinatal insults cause a self-perpetuating cascade of peripheral and cerebral inflammation that plays a critical role in the etiology of diffuse white and grey matter injuries that underlies a spectrum of connectivity deficits in survivors from extremely preterm birth. This review focuses on chorioamnionitis and hypoxia-ischemia, which are two important antenatal risk factors for preterm brain injury, and highlights the latest insights on its pathophysiology, potential treatment, and future perspectives to narrow the translational gap between preclinical research and clinical applications.
全世界早产儿的发病率为 1500 万例，早产儿是导致新生儿死亡和发病的主要原因，同时也带来了相应的社会和经济负担。由于大脑未成熟，早产儿易患终身性神经发育障碍。风险与出生时的成熟度成反比。在大多数极早产儿（<28 周妊娠）中，围产期脑损伤与多种炎症性围产期触发因素有关，这些因素包括产前感染（即绒毛膜羊膜炎）、缺氧缺血和各种产后损伤性触发因素（即氧化应激、败血症、机械通气、血流动力学不稳定）。这些围产期损伤会引发外周和大脑炎症的自我持续级联反应，在早产儿幸存者广泛存在的连接缺陷的病因中起着关键作用。这篇综述重点介绍了绒毛膜羊膜炎和缺氧缺血，这是早产儿脑损伤的两个重要产前危险因素，并强调了其病理生理学、潜在治疗方法以及缩小临床前研究和临床应用之间转化差距的未来展望的最新见解。
