World Prematurity Day - Shedding Light on the BLACK BOX of Preterm Brain Development and Outcomes
Extremely preterm birth is one of the greatest challenges in neonatal health today. Every year, thousands of families face the uncertainty of seeing their tiny newborns survive against the odds, knowing that survival is just the first step in a long journey. A recent population-based study from Sweden led by Aden et al 2025 paints a striking picture, over the past two decades, survival rates for extremely preterm infants have improved a triumph of modern perinatal care. But despite this progress, neurodevelopmental outcomes , such as cognitive and motor function, have not improved in the same way (https://doi.org/10.1136/archdischild-2024-327919). This gap, often described as a ‘ BLACK BOX ’, leaves clinicians and researchers puzzled. Why does survival improve, but development remains stubbornly plateaued? The answer is complex. Biological vulnerability e.g., the immaturity of organs, underdeveloped neural networks, plays a central role, but it is not the whole story. En...