The Saudi Journal of Medical Insights

Preterm birth, defined as delivery before 37 weeks of gestation, is a major global health challenge. While advancements in
neonatal care have significantly improved survival rates, there is growing recognition of the long-term consequences for
organ systems undergoing critical development during the truncated third trimester. The brain and urological system are
particularly vulnerable, yet their interconnected outcomes are often examined in isolation. This comprehensive narrative
review synthesizes current evidence on the impact of maternal preterm labor and subsequent preterm birth on the
coordinated development of the neurological and urological systems in children, tracing pathways from etiology to lifelong
health. A narrative search was conducted across major databases (PubMed, Embase, Scopus) for studies, reviews, and meta
analyses published from 1990 onward. Findings were integrated thematically to explore definitions, normal development,
pathophysiological mechanisms, epidemiological evidence, and long-term outcomes. Inflammation, oxidative stress, and
hemodynamic instability as shared mechanisms disrupting cerebral white matter development and nephrogenesis.
Epidemiological data confirm a strong, dose-dependent relationship between earlier gestational age and increased risks of
neurodevelopmental impairments (e.g., cerebral palsy, cognitive deficits, executive dysfunction, ADHD) and urological
renal sequelae (e.g., reduced nephron endowment, bladder dysfunction, hypertension, and chronic kidney disease). These
outcomes are frequently co-morbid, linked by both shared initial insults and direct neural injury affecting bladder control.
The consequences extend into adulthood, demanding a lifespan model of care. Preterm birth is not merely a neonatal event
but a lifelong condition with interconnected neuro-urological morbidities. A proactive, integrated approach to monitoring
and intervention, from the neonatal intensive care unit through adult healthcare, is essential to mitigate risks and optimize
the quality of life for this growing population.