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PEDIATRICS Vol. 104 No. 3 September 1999, pp. 541-550

SPECIAL ARTICLE:
Brain Damage in Preterm Newborns: Might Enhancement of Developmentally Regulated Endogenous Protection Open a Door for Prevention?

Received Nov 11, 1998; accepted Feb 8, 1999.

Olaf Dammann and Alan Leviton

From the Neuroepidemiology Unit, Department of Neurology, Children's Hospital, Boston, Massachusetts.

We present a two-component model of brain white matter damage in preterm neonates. The insult component comprises infection and hypoxia-ischemia, which are both associated with inflammation-related abnormalities in the white matter. The developmental component comprises at least three factors, ie, immaturity of the ependymal/endothelial, oligodendroglial, and endogenous protection systems. All three factors are likely contributors to an increased vulnerability of the preterm newborn's white matter. In this article, we focus on recent developments in oligodendrocyte biology that support the view of certain cytokines and growth factors as oligotrophins based on their capability to enhance oligodendrocyte development or survival. We suggest that research into networks of developmentally regulated endogenous protectors (such as oligotrophins) is necessary to broaden our perspectives in brain injury prevention in preterm newborns.

 Key words:  infant, premature, brain development, cell protection, oligodendrocytes.




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