Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia; Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.
Newborn Care Centre, The Royal Hospital for Women, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia.
Semin Fetal Neonatal Med. 2022 Jun;27(3):101370. doi: 10.1016/j.siny.2022.101370. Epub 2022 Jun 18.
Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developmental care. Avoidance of complications that trigger ischemia and inflammation is vital for minimizing brain dysmaturation and injury, particularly of the white matter. Neurodevelopmental surveillance, early diagnosis of cerebral palsy and early intervention are essential for optimizing long-term outcomes and quality of life. Research priorities include further evaluation of putative neuroprotective agents, and investigation of common neonatal interventions in trials adequately powered to assess neurodevelopmental outcome.
围产期护理的进步使极早产儿的存活率和生存质量得到了显著提高。保护发育中的大脑并减少极早产儿出生后的神经发育后遗症是研究和临床护理的战略重点。目前有许多针对早产儿的神经保护的循证干预措施，包括预防早产和多胎妊娠（体外受精时仅植入一个胚胎），以及进行产前护理以优化胎儿健康、支持新生儿过渡的策略，和神经保护的发育护理。避免引发缺血和炎症的并发症对于最大限度地减少脑发育不良和损伤至关重要，尤其是对白质的损伤。神经发育监测、脑瘫的早期诊断和早期干预对于优化长期结局和生活质量至关重要。研究重点包括进一步评估潜在的神经保护剂，并在有足够能力评估神经发育结局的试验中研究常见的新生儿干预措施。
