Diminishing the Risk of Brain Damage in the Premature Infant, 9/2000 

Prematurity is an important risk factor for the subsequent development of cerebral palsy. In the premature infant, there are two principle mechanisms responsible for developmental brain damage: hemorrhage into the ventricles (cavities) in the brain; and lack of blood and/or oxygen to a vulnerable part of the developing brain. This latter mechanism is the more common and leads to poor formation of the brain's "white matter": the insulating material that surrounds the brain nerve cell processes. This white matter insufficiency disturbance is called PVL, periventricular (around the ventricles) leukomalacia (deficiency of white matter).  

Another disturbance associated with prematurity is the respiratory distress syndrome (RDS). It occurs because the premature infant's lungs do not function properly; this is particularly true in premature infants of less than 31 weeks of gestational (intra-uterine) age. Fortunately, the use of hormone therapy (glucocorticoids) given to the mother prior to delivery often can prevent RDS.  

There have been preliminary observations that the occurrence of PVL is also decreased when women in premature labor have been given hormones to prevent RDS in their infants. Do they really work in preventing PVL and, if so, which of the available hormones works better?  

To answer these questions, a team of investigators in several hospitals in France did a careful analysis of the records of 883 live born infants.¹ They found there was a substantial reduction of the occurrence of PVL in very premature infants whose mothers had received one of the two hormones commonly used prior to delivery to prevent RDS: betamethasone.  

Comment
This is a very important clinical finding to assist in the prevention of cerebral palsy in infants at high risk: the very premature infant. Of the two glucocorticoid hormones now often given to the mother in pre-term labor to prevent respiratory distress syndrome, one was found to be important also for the prevention of cerebral palsy: bethamethasone. This finding adds to our ability to address the problem of preventing brain damage in the very premature infant.

¹Baud, O. et al. Antenatal Glucocorticoid Treatment and Cystic Periventricular Leukomalacia in Very Premature Infants. NEJM 1999; 341: 1190-1196 

© UCP Research & Education Foundation, September 2000

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