Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

In the perinatal period the developing brain is extremely vulnerable for a variety of insults. Perinatal conditions, such as extreme prematurity, perinatal asphyxia, and their complications can lead to lifelong sensorimotor, cognitive and behavioral impairment. Prediction of long-term neurodevelopment of preterm and ill term infants at risk for brain injury at an early stage remains a big challenge. Identification of brain lesions and disturbed function is essential for an accurate diagnosis. Currently, the prediction of the outcome is based on a variety of diagnostic tools and clinical assessment of developmental milestones. Several methods for early diagnosis and neuromonitoring of brain injury are available, such as cerebral ultrasound, magnetic resonance imaging (MRI) at term-equivalent age as well as neuromonitoring tools, such as amplitude-integrated electroencephalography (aEEG) and/or conventional EEG and near-infrared spectroscopy (NIRS), general movements assessment (GMA) and clinical assessment by, e.g., the Hammersmith neonatal/infant neurological examination (HNNE/HINE), all of which require substantial personnel and also technical resources. As better biomarkers are urgently needed scientific investigations currently focus on identification of innovative biomarker patterns (omics) and (epi)genetic markers. Furthermore, the individual child’s development is determined not only by clinical risk factors, such as associated diseases but also by the socioeconomic environment. Estimation of the most accurate and early prognosis is cost-intensive, but crucial to adequately guide patients and counsel families. The initiation of early interventions is important as the plasticity of the developing brain is highest around birth and in the first few months of life. This review focuses on the characterization of the abovementioned diagnostic tools and the possibilities for combination for outcome prognosis. In addition, an outlook is given on how new technologies can facilitate the prediction of development and follow-up care of these children following perinatal brain injury.