Premature birth & role of neuroprotection for the mother and premature baby

Abstract

Premature infants are those born before 37th weeks' gestation.prevelance:6% of singletons,46% of twin ,79% of triplet or higher-order deliveries. About 1.4% are before 32th weeks-when neonatal problems are greatest. In 25% delivery is elective.10% are due to multiple pregnancy;25% are due to ante-partum haemorrhage, cervical incompetence, amnionitis, utrine abnormalities, diabetes, polyhydraminos, pyelonephritis, or other infections.in 40% the cause is unknown, but abnormal genital tract colonization (bacterial vaginosis) with ureplasama and Mycoplasama hominis is implicated, as either a risk factor or risk marker .if treating 2nd trimester vaginosis is necessary, use macrolide or clindamycin,(not metronidazole which is associated with increase premature birth rates).prophylactic antibiotics in spontaneous preterm labour with intact membranes increase risk of cerebral palsy, and are not recommended. Prevention of preterm birth and early intervention given signs of imminent intrauterine infection can reduce the incidence of perinatal cerebral injury. It has been shown that administering magnesium intravenously to women at imminent risk of a preterm birth leads to a significant reduction in the likelihood of the infant developing cerebral palsy and motor skill dysfunction. It has also been demonstrated that delayed clamping of the umbilical cord after birth reduces the rate of brain hemorrhage among preterm infants by up to 50%. In addition, mesenchymal stem cells seem to have significant neuroprotective potential in animal experiments, as they increase the rate of regeneration of the damaged cerebral area. Clinical tests of these types of therapeutic intervention measures appear to be imminent. In the last trimester of pregnancy, the serum concentrations of estradiol and progesterone increase significantly. Preterm infants are removed abruptly from this estradiol and progesterone rich environment. It has been demonstrated in animal experiments that estradiol an