Neurologic and developmental issues are common complications that constitute a cause of major concern in preterm infants. We very well know that preterm birth is a major risk factor for neurologic deficits or abnormalities in early childhood and later life. The number of patients seen with cognitive impairment has continued to rise. Pursuing the reason for this, more scientists have begun to study the types of brain injury seen in infants and their risk factors. Some of these injuries like white matter injury, cerebellar hemorrhage, and germinal matrix intraventricular hemorrhage have been identified as common injuries that may occur in preterm infants resulting in varying manifestations of neurological dysfunction that consequently translate to reduced quality of life and other significant health complications in later life. 
White Matter Injury Causes Cognitive Impairment, Visual Problems, and Low IQ
Injury to the white matter has been identified as the commonest form of brain injury found in preterm infants with a wide range of damage to the nervous system with a significant impact on the quality of life. This kind of injury often occurs sometime between the 23rd to 32nd week of gestation. The top risk factors for these injuries occurring include hypoxia-ischemia and inflammation resulting from infection during the perinatal and neonatal period.
White matter injury may take any of the three major pathological forms which include; focal cystic necrosis, focal microscopic necrosis, and diffuse non-necrotic lesions. All pathological forms manifest in addition to diffuse gliosis. The most severe form of white matter injury is the cystic form which has been associated with significant impairment in the development of affected infants. This form of white matter injury has been associated with cerebral palsy in 75% of affected infants, cognitive impairment, visual impairment, and even seizure disorders.
The diffuse non-necrotic lesions which may occur on the white matter have been linked to low IQ, poor academic performance, and impairment in attention, motor function, language, and information processing.
Brain Dysmaturation Influences Neurological Impairment And Occurs Due To White Matter Injury
The term “brain dysmaturation” refers to the effects of brain injury on the development of the white and gray matter of the brain. Dysmaturation as well as the primary injury to the brain have been identified as the key players in the development of the common manifestations of neurological abnormalities in infants born preterm.
Read Also: DNA Responses Are Responsible for Long-Term Health Problems Caused by Childhood Trauma
Injury to the immature white matte results in failure of maturation of the preoligodendrocytes and consequent hypomyelination. This may be followed by impairment of the maturation of neuronal and axonal structures.
Impaired Neuronal Maturation May Be the Primary Cause of Neurological Dysfunction
Apart from brain dysmaturation and its consequences, impairment in neuronal maturation may also be the key event leading to neurological or developmental problems in preterm infants. A recent study discovered an alteration in the maturational decline expected in fractional anisotropy in the cortex occurring without evidence of white matter injury in preterm infants on admission. It is possible that impairment in the development of cortical gray matter plays a role.
Studies have also identified factors like; nutrition, growth, harsh experiences during NICU admission including pain, absence of nurturing, healing touch and exposure to human voices, and exposure to harsh light and sound, as some of the influences behind poor brain development of preterm infants during their hospital admission.
Clinical Significance
Under current-day guidelines, preventing the development of neurological complications remains a major focus in the management of preterm infants. Understanding the mechanisms behind these common neurological complications provides some insight into possible improvements in current management strategies to improve treatment outcomes and neurological performance in later life.
Read Also: Post-Traumatic Stress Causes an Imbalance in Brain Connectivity Study Shows
Conclusion
This review tries to highlight the common brain injuries expected in preterm infants and the need for commitment to improving intensive care for preterm infants. Whilst the incidence of neurological complications is reported to be on the decrease, further research is needed to develop realistic approaches to prevent serious complications in children born preterm.
References
Inder, T. E., Volpe, J. J., & Anderson, P. J. (2023). Defining the Neurologic Consequences of Preterm Birth. The New England journal of medicine, 389(5), 441–453. https://doi.org/10.1056/NEJMra2303347
