Peculiarities of development and lesions of the central nervous system in late preterm newborns

The last weeks of pregnancy are a critical period of intrauterine development of the central nervous system. In late preterm infants born at gestational age 340/7 — 366/7 weeks, the maturation of the central nervous system continues postnatally, which determines its high vulnerability to various pathologic effects. Morphofunctional immaturity and frequent complications of the neonatal period increase the likelihood of early brain lesions leading to further disorders of neuropsychiatric development. Even in the absence of clinically significant neurological abnormalities in the neonatal period, late preterm neonates have a risk of social-adaptive, behavioral, motor and cognitive impairments in later life. Predicting the outcome of central nervous system lesions in late preterm neonates is possible with the help of neuroimaging methods, as well as with the use of specialized tools to assess various areas of psychomotor development. Modern approaches to prevent neurological complications include prevention and treatment of hypoxia, hypoglycemia, hyperbilirubinemia, infections, provision of adequate nutritional support and adherence to vaccination in late preterm neonates.

1. Ohuma E.O., Moller A.B., Bradley E., Chakwera S., Hussain-Alkhateeb L., Lewin A. еt al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023; 402(10409): 1261– 1271. DOI: 10.1016/S0140-6736(23)00878-4

2. Hamilton B.E., Martin J.A., Osterman M.J.K. Births: Provisional data for 2022. Vital Statistics Rapid Release; no 28. Hyattsville, MD: National Center for Health Statistics. June 2023. DOI: 10.15620/cdc:127052

3. Healthcare in Russia. 2023: Statistical collection. Rosstat. M., Z–46 2023; 179 p. (in Russ.)

4. Huff K., Rose R.S., Engle W.A. Late Preterm Infants: Morbidities, Mortality, and Management Recommendations. Pediatr Clin North Am. 2019; 66(2): 387–402. DOI: 10.1016/j.pcl.2018.12.008

5. Sharma D., Padmavathi I.V., Tabatabaii S.A., Farahbakhsh N. Late preterm: a new high-risk group in neonatology. J Matern Fetal Neonatal Med. 2021; 34(16): 2717–2730. DOI: 10.1080/14767058.2019.1670796

6. Karavaeva A.L., Timofeeva L.A., Tsechoeva T.K., Tyutyunnik V.L., Kan N.E., Zubkov V.V. Late prematurity in the zone of the increased attention. Literature review. Part 2. Features of the morbidity of late premature newborns. Neonatologiya: novosti, mneniya, obuchenie. 2023; 11(1): 65–75. (in Russ.). DOI: 10.33029/2308-2402-2023-11-1-65-75

7. Sofronova L.N., Fedorova L.A., Kyanksep A.N., Shevareva E.A., Yalfimova E.A. Late preterm — a group of high risk of early and distant complications. Pediatriya im. G.N. Speranskogo. 2018; 97(1): 131–140. (in Russ.) DOI: 10.24110/0031-403X-2018-97-1-131-140

8. Sarkisyan E.A., Dumova S.V., Chugunova O.L., Ustenko E.S., Shumilov P.V. Anatomical and physiological features of late premature infants leading to the formation of various pathological processes. Pediatriya im. G.N. Speranskogo. 2023; 102(1): 71–81. (in Russ.) DOI: 10.24110/0031-403X2023-102-1-71-81

9. Volpe J.J. Commentary — The late preterm infant: Vulnerable cerebral cortex and large burden of disability. J Neonatal Perinatal Med. 2022; 15(1): 1–5. DOI: 10.3233/NPM-210803

10. Favrais G., Saliba E. Neurodevelopmental outcome of latepreterm infants: Literature review. Arch Pediatr. 2019; 26(8): 492–496. DOI: 10.1016/j.arcped.2019.10.005

11. Ramdin T., Ballot D., Rakotsoane D., Madzudzo L., Brown N., Chirwa T. еt al. Neurodevelopmental outcome of late preterm infants in Johannesburg, South Africa. BMC Pediatr. 2018; 18(1): 326. DOI: 10.1186/s12887-018-1296-3

12. Townley Flores C., Gerstein A., Phibbs C.S., Sanders L.M. Short-Term and Long-Term Educational Outcomes of Infants Born Moderately and Late Preterm. J Pediatr. 2021; 232: 31–37. e2. DOI: 10.1016/j.jpeds.2020.12.070

13. Shah P., Kaciroti N., Richards B., Oh W., Lumeng J.C. Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten. Pediatrics. 2016; 138(2): e20153496. DOI:10.1542/peds.2015-3496

14. Ballantyne M., Benzies K.M., McDonald S., Magill-Evans J., Tough S. Risk of developmental delay: Comparison of late preterm and full-term Canadian infants at age 12 months. Early Hum Dev. 2016; 101: 27–32. DOI: 10.1016/j.earlhumdev.2016.04.004

15. Sejer E.P.F., Bruun F.J., Slavensky J.A., Mortensen E.L., Schiøler Kesmodel U. Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study. BMJ Open. 2019; 9(9): e028982. DOI: 10.1136/ bmjopen-2019-028982

16. Yakhiyeva-Onikhimovskaya D.A., Kolesnikova S.M., Filippova V.V. Comparative characteristics of newborns with “late preterm” and term newborns with fetal growth retardation syndrome. Zdravookhranenie Dal’nego Vostoka. 2020; 1(83): 59–64. (in Russ.). DOI: 10.33454/1728-1261-2020-1-59-64

17. Laptook A.R. Neurologic and metabolic issues in moderately preterm, late preterm, and early term infants. Clin Perinatol. 2013; 40(4): 723–738. DOI: 10.1016/j.clp.2013.07.005

18. Özek E., Kersin S.G. Intraventricular hemorrhage in preterm babies. Turk Pediatri Ars. 2020; 55(3): 215–221. DOI: 10.14744/TurkPediatriArs.2020.66742

19. Scheinost D., Chang J., Lacadie C., Brennan-Wydra E., Constable R.T., Chawarska K. et al. Functional connectivity for the language network in the developing brain: 30 weeks of gestation to 30 months of age. Cereb Cortex. 2022; 32(15): 3289–3301. DOI:10.1093/cercor/bhab415

20. Fumagalli M., Ramenghi L.A., De Carli A., Bassi L., Farè P., Dessimone F. еt al. Cranial ultrasound findings in late preterm infants and correlation with perinatal risk factors. Ital J Pediatr. 2015; 41: 65. DOI: 10.1186/s13052-015-0172-0

21. Volyanyuk E.V., Zakirova A.M. Borderline states during the adaptation period of late premature infants. Prakticheskaya meditsina. 2020; 18(6): 97–100. (in Russ.). DOI: 10.32000/2072-1757-2020-6-97-100

22. Pisani F., Facini C., Bianchi E., Giussani G., Piccolo B., Beghi E. Incidence of neonatal seizures, perinatal risk factors for epilepsy and mortality after neonatal seizures in the province of Parma, Italy. Epilepsia. 2018; 59(9): 1764–1773. DOI: 10.1111/epi.14537

23. Elbaum C., Beam K.S., Dammann O., Dammann C.E.L. Antecedents and outcomes of hypothermia at admission to the neonatal intensive care unit. J Matern Fetal Neonatal Med. 2021; 34(1): 66–71. DOI: 10.1080/14767058.2019.1597043

24. Bykova Yu.K., Filippova E.A., Vatolin K.V., Ushakova L.V., Amirkhanova D.Yu. Structural changes in the prixic-ischemic brain based on the central nervous system in children of different gestational ages. Comparison of the echographic picture with the data of morphological studies. Neonatologiya: novosti, mneniya, obuchenie. 2016; 3: 28–38. (in Russ.).

25. Draft clinical recommendations of the Russian Association of Perinatal Medicine Specialists together with the Russian Society of Neonatologists: a healthy newborn born in a hospital. 2023. (in Russ.). https://www.raspm.ru/files/zdorovyi_stacionar.pdf / Ссылка активна на 4.04.2024.

26. Mazmanyan P.A., Nikoghosyan K.V., Kerobyan V.V., Mellor K.J., Diez-Sebastian J., Martinez-Biarge M. Preterm cranial ultrasound scanning is both feasible and effective in a middle-income country. Acta Paediatr. 2016; 105(7): e291–9. DOI: 10.1111/apa.13411

27. Diwakar R.K., Khurana O. Cranial Sonography in Preterm Infants with Short Review of Literature. J Pediatr Neurosci. 2018; 13(2): 141–149. DOI: 10.4103/jpn.JPN_60_17

28. Ballardini E., Tarocco A., Baldan A., Antoniazzi E., Garani G., Borgna-Pignatti C. Universal cranial ultrasound screening in preterm infants with gestational age 33–36 weeks. A retrospective analysis of 724 newborns. Pediatr Neurol. 2014; 51(6): 790–794. DOI: 10.1016/j.pediatrneurol.2014.08.012

29. Astasheva I.B., Guseva M.R., Atamuradov R., Marenkov V.V., Kyun Yu.A. Modern possibilities of diagnosing lesions of the visual analyzer in perinatal lesions of the central nervous system in full-term and premature infants. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2022; 122(12): 7–15. (in Russ.). DOI: 10.17116/jnevro20221221217

30. Walsh J.M., Doyle L.W., Anderson P.J., Lee K.J., Cheong J.L. Moderate and late preterm birth: effect on brain size and maturation at term-equivalent age. Radiology. 2014; 273(1): 232–240. DOI: 10.1148/radiol.14132410.

31. Cheong J.L., Thompson D.K., Spittle A.J., Potter C.R., Walsh J.M., Burnett A.C. et al. Brain Volumes at Term-Equivalent Age Are Associated with 2-Year Neurodevelopment in Moderate and Late Preterm Children. J Pediatr. 2016; 174: 91–97.e1. DOI: 10.1016/j.jpeds.2016.04.002.

32. Clinical recommendations of the Russian Association of Perinatal Medicine Specialists: amplitude-integrated electroencephalography in assessing the functional state of the central nervous system in newborns of different gestational ages. 2015. https://www.raspm.ru/files/elektro-enctfalo-grafia.pdf / Ссылка активна на 4.04.2024

33. Jiang C.M., Yang Y.H., Chen L.Q., Shuai X.H., Lu H., Xiang J.H. et al. Early amplitude-integrated EEG monitoring 6 h after birth predicts long-term neurodevelopment of asphyxiated late preterm infants. Eur J Pediatr. 2015; 174(8): 1043–1052. DOI: 10.1007/s00431-015-2490-z

34. Shen L., Tao M.Y., Shi Y.X., Yin J., Yin Q.G. Value of amplitude-integrated electroencephalogram combined with quantitative indices of cranial magnetic resonance imaging in predicting short-term neurodevelopment in moderately and late preterm infants: a prospective study. Zhongguo Dang Dai Er Ke Za Zhi. 2021; 23(10): 987–993. English, Chinese. DOI: 10.7499/j.issn.1008-8830.2106077

35. Srinivas J.R. Neurodevelopmental outcome of late-preterm infants: A pragmatic review. Aust J Gen Pract. 2018; 47(11): 776–781.

36. Karnati S., Kollikonda S., Abu-Shaweesh J. Late preterm infants — Changing trends and continuing challenges. Int J Pediatr Adolesc Med. 2020; 7(1): 36–44. DOI: 10.1016/j.ijpam.2020.02.006

37. Smyrni N., Koutsaki M., Petra M., Nikaina E., Gontika M., Strataki H. et al. Moderately and Late Preterm Infants: Short- and Long-Term Outcomes From a Registry-Based Cohort. Front Neurol. 2021; 12: 628066. DOI: 10.3389/fneur.2021.628066.

38. You J., Shamsi B.H., Hao M.C., Cao C.H., Yang W.Y. A study on the neurodevelopment outcomes of late preterm infants. BMC Neurol. 2019; 19(1): 108. DOI: 10.1186/s12883-019-1336-0

39. Hirvonen M., Ojala R., Korhonen P., Haataja P., Eriksson K., Gissler M. et al. Cerebral palsy among children born moderately and late preterm. Pediatrics. 2014; 134(6): e1584– e1593. DOI: 10.1542/peds.2014-0945

40. Pisani F., Prezioso G., Spagnoli C. Neonatal seizures in preterm infants: A systematic review of mortality risk and neurological outcomes from studies in the 2000’s. Seizure. 2020; 75: 7–17. DOI: 10.1016/j.seizure.2019.12.005

41. McLaren R.Jr., Clark M., Narayanamoorthy S., Rastogi S. Antenatal factors for neonatal seizures among late preterm births. J Matern Fetal Neonatal Med. 2022; 35(25): 9544–9548. DOI: 10.1080/14767058.2022.2047924

42. Balasundaram P., Avulakunta I.D. Bayley Scales Of Infant and Toddler Development. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 21, 2022. https://pubmed.ncbi.nlm.nih.gov/33620792 / Ссылка активна на 4.04.2024.

43. Del Rosario C., Slevin M., Molloy E.J., Quigley J., Nixon E. How to use the Bayley Scales of Infant and Toddler Development. Arch Dis Child Educ Pract Ed. 2021; 106(2): 108–112. DOI: 10.1136/archdischild-2020-319063

44. Guddemi M., Sambrook A., Wells S., Randel B., Fite K., Selva G., Gagnon K. Arnold Gesell’s Developmental Assessment Revalidation Substantiates Child-Oriented Curriculum. Sage Open, 2014; 4(2). SAGE Open. 4. DOI: 10.1177/2158244014528918

45. Johnson S., Bountziouka V., Brocklehurst P., Linsell L., Marlow N., Wolke D., Manktelow B.N. Standardisation of the Parent Report of Children’s Abilities-Revised (PARCA-R): a norm-referenced assessment of cognitive and language development at age 2 years. Lancet Child Adolesc Health. 2019; 3(10): 705–712. DOI: 10.1016/S2352-4642(19)30189-0

46. Frontiers Production Office. Erratum: The MacArthur-Bates Communicative Development Inventories: updates from the CDI Advisory Board. Front Psychol. 2023; 14: 1258830. Published 2023 Aug 10. DOI: 10.3389/fpsyg.2023.1258830

47. Chin W.C., Wu W.C., Hsu J.F., Tang I., Yao T.C., Huang Y.S. Correlation Analysis of Attention and Intelligence of Preterm Infants at Preschool Age: A Premature Cohort Study. Int J Environ Res Public Health. 2023; 20(4): 3357. DOI: 10.3390/ijerph20043357

48. Perra O., McGowan J.E., Grunau R.E., Doran J.B., Craig S., Johnston L. et al. Parent ratings of child cognition and language compared with Bayley-III in preterm 3-year-olds. Early Hum Dev. 2015; 91(3): 211–216. DOI: 10.1016/j.earlhumdev.2015.01.009

49. Bogičević L., Verhoeven M., van Baar A.L. Toddler skills predict moderate-to-late preterm born children’s cognition and behaviour at 6 years of age. PLoS One. 2019; 14(11): e0223690. DOI: 10.1371/journal.pone.0223690

50. Hay W.W. Optimizing nutrition of the preterm infant. Zhongguo Dang Dai Er Ke Za Zhi. 2017; 19(1): 1–21. DOI: 10.7499/j.issn.1008–8830.2017.01.001

51. Sarkisyan E.A., Dumova S.V., Volkova A.I., Chugunova O.L., Zhuravleva I.V., Levchenko L.A. еt al. Current approaches to respiratory pathology in late preterm infants. Ros Vestn Perinatol i Pediatr 2023; 68:(4): 14–ХХ. (in Russ.). DOI: 10.21508/1027-4065-2023-68-4-14-ХХ

52. Wight N.E. Academy of Breastfeeding Medicine. ABM Clinical Protocol #1: Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term and Late Preterm Neonates, Revised 2021. Breastfeed Med. 2021; 16(5): 353– 365. DOI: 10.1089/bfm.2021.29178.new

53. Battin M., Harris D.L., Hegarty J.E., Weston P.J. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database Syst Rev. 2022; 3(3): CD011027. DOI: 10.1002/14651858.CD011027.pub3

54. Yalçinkaya R., Zenciroğlu A. Evaluation of Neonatal Polycythemia in Terms of Gestational Age, Hematocrit, and Platelet Levels. Türkiye Çocuk Hast Derg. 2022; 16(6): 495–500. DOI: 10.4274/tmsj.galenos.2023.2022-8-1

55. Hulzebos C.V., Vitek L., Coda Zabetta C.D., Dvořák A., Schenk P., van der Hagen E.A.E. et al. Screening methods for neonatal hyperbilirubinemia: benefits, limitations, requirements, and novel developments. Pediatr Res. 2021; 90(2): 272–276. DOI: 10.1038/s41390-021-01543-1

56. Wallenstein M.B., Bhutani V.K. Jaundice and kernicterus in the moderately preterm infant. Clin Perinatol. 2013; 40(4): 679–688. DOI: 10.1016/j.clp.2013.07.007

57. Lastrucci V., Puglia M., Pacifici M., Buscemi P., Sica M., Alderotti G. et al. Delayed Start of Routine Vaccination in Preterm and Small-for-Gestational-Age Infants: An Area-Based Cohort Study from the Tuscany Region, Italy. Vaccines (Basel). 2022; 10(9): 1414. DOI: 10.3390/ vaccines10091414

58. Puopolo K.M., Benitz W.E., Zaoutis T.E. Committee on fetus and newborn; committee on infectious diseases. Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics. 2018; 142(6): e20182894. DOI: 10.1542/peds.2018-2894