Promoting sound development of preterm infants in the name of developmental neuroscience: Beyond advanced life support and neuroprotection.
Promoting sound development of preterm infants in the name of developmental neuroscience: Beyond advanced life support and neuroprotection.
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以发育神经科学的名义促进早产儿的健康发育：超越先进的生命支持和神经保护。
DOI：
10.1016/j.pedneo.2020.11.006
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Saitoh S.
中科院分区：
文献类型：
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作者：
Iwata O;Iwata S;Lin YC;Kato S;Mizutani Y;Hisano T;Kinoshita M;Fukaya S;Kawase K;Saitoh S.
尽管极早产儿的存活机会增加，但他们的长期认知结果仍然很差，与足月出生的同龄人相比，儿童期认知障碍的发生率增加，成年后接受高等教育的机会减少。鉴于相当一部分早产儿即使在出生时没有明显的哨兵事件，也会出现认知障碍，并且在足月等效年龄时评估MRI上的脑病变，未来改善结局的策略可能需要解决脑功能障碍，这无法通过对出生前后缺氧缺血引发的损伤级联反应的经典理解来解释。发展保健已被提出，以尽量减少与早产有关的神经发育障碍。然而，相当多的护理模式，环境设置和程序提供的发展护理的当前风格似乎提供婴儿的健康发展的好处不大。虽然很明显，先进的生命支持和神经保护治疗远远不能弥补早产的负担，但在建立循证发育护理之前，研究人员需要进一步努力填补胎儿和新生儿脑功能的知识空白。临床医生需要培养一种能力，将基础研究和转化研究的结果转化为潜在的偏见和局限性。新生儿护理需要重新评估，包括但不限于发育护理，因为早产儿的任何感觉输入和运动反应可能最终影响其认知功能。
Despite the increased survival opportunities for extremely preterm infants, their long-term cognitive outcomes remain poor, with increased incidence of cognitive impairments in childhood and reduced opportunities to attend higher education in young adulthood compared to their term-born peers. Given that a considerable fraction of preterm infants develop cognitive impairments even without apparent sentinel events at birth and cerebral lesions on MRI assessed at term equivalent age, future strategies to improve the outcome may need to address cerebral dysfunction, which cannot be explained by the classical understanding of the injury cascade triggered by hypoxia-ischaemia around birth. Developmental care has been proposed to minimize neurodevelopmental impairments related to preterm birth. However, considerable modes of cares, environmental settings and procedures provided by the developmental care of current style appear to offer little benefit to the sound development of infants. Although it is obvious that advanced life support and neuroprotective treatments fall far short in compensating for the burden of preterm birth, researchers need to make further effort to fill the knowledge gap in the cerebral function of foetuses and newborn infants before establishing evidence-based developmental care. Clinicians need to develop an ability to translate the findings from basic and translational studies incorporating their potential biases and limitations. Care for newborn infants needs to be reassessed, including but not limited to developmental care, in the context that any sensory input and motor reaction of preterm infants may ultimately affect their cognitive functioning.