Defining the Neurologic Consequences of Preterm Birth

( N Engl J Med . 2023; 389:441–53) Approximately 15 million babies are born prematurely (before 37 wk gestation) each year, making prematurity the leading cause of neonatal deaths. Despite advancements in perinatal health care, preterm survivors still face a high risk of long-term issues, especially neurological and developmental disabilities. While severe cerebral palsy rates have decreased in the past 2 decades, cognitive impairment and social-emotional challenges among preterm children and young adults remain prevalent. Very preterm children (born <32 wk) typically exhibit lower intelligence quotient scores, with more significant deficits in those born before 26 weeks. The variability in outcomes reflects the extent of brain injury and dysmaturation, with earlier births carrying a risk that is more significant. New insights from advanced neuroimaging and developmental neuroscience emphasize that both brain injury and impaired brain development contribute to adverse neurodevelopmental outcomes. This review explores the major forms of brain injury, subsequent dysmaturation, mediating factors, and their impact on preterm infant neurodevelopment and aims to guide neonatal clinicians in implementing future neuroprotective strategies for better long-term outcomes.