Group dedicated to minimizing brain injury in premature babies launches in Great Britain

Prematurity and brain damage

There is a well recognized correlation between prematurity and brain damage. The two most common types of brain injuries in newborn premature babies are: (1) intraventricular hemorrhage (IVH); and (2) periventricular leukomalacia (PVL). Long ago, it was believed that prematurity directly leads to brain damage. This thinking, however, has changed over the years.

It is now believed that there are underlying mechanisms that cause or contribute to IVH and/or PVL in premature infants.

What are common causes of IVH?

1. Sepsis
2. Apnea and bradycardia
3. Respiratory Distress
4. Hypotension

What are common causes of PVL?

1. Hypoxia and Ischemia
2. Infection
3. Fetal Inflammatory Response Syndrome (FIRS)
4. Respiratory Distress Syndrome

PERIPrem - bundles for avoiding brain damage and death in premature infants

Just last week, a collaborative in Great Britain launched PERIPrem. PeriPREM stands for Perinatal Excellence to Reduce Injury in Premature Birth. This group/network looks like a fabulous resource for those health care providers dedicated to getting the best outcome for their patients.

PERIPrem identified a bundle of interventions that can help avoid brain injury and death in premature infants.

What interventions can help avoid brain injury and death in premature babies?

1. Birth in a tertiary facility
2. Antenatal steroids (e.g., betamethasone)
3. Magnesium sulfate
4. Delayed cord clamping
5. Thermoregulation
6. Early breast milk
7. Volume target ventilation
8. Caffeine
9. Prophylactic hydrocortisone
10. Probiotics

Indeed, as PERIPrem points out on its website, each of these intervention can help avoid brain damage in a preterm infant. Each of these treatments/intervention have been the standard of care for some time now.

Premature birth, cerebral palsy and lawsuits

The failure to follow the standard of care in the management of an anticipated preterm birth, or in the management of a preterm newborn, can result in brain damage and cerebral palsy. As an example, it is the the standard of care to administer betamethasone to any mother with an anticipated preterm birth between 24 and 34 weeks gestation. Failing to give betamethasone can result in immature lungs, respiratory distress syndrome, PVL, and resultant cerebral palsy.

It is refreshing to see an organization with the direct aim of using the above interventions to avoid brain injury in premature newborns.