Shaping the Developing Brain: The Impact of Environmental Factors on At-risk Paediatric Population

This doctoral thesis investigates how modifiable environmental factors influence neurodevelopment in paediatric populations with heightened neurological risk. Adopting a multidisciplinary approach, the study examines three interconnected domains: the planetary environment, the family environment, and the neonatal intensive care unit (NICU) setting. The first section evaluates the impact of climate change, specifically, temperature fluctuations, air pollution (notably PM2.5), and extreme weather events, on neurodevelopmental outcomes such as preterm birth and paediatric epilepsy. A five-year cohort study (2019–2023) at a leading Italian paediatric hospital revealed significant associations between environmental stressors and emergency department admissions for seizures, with evidence indicating both immediate and delayed effects of temperature and pollution. The second section explores the family environment, emphasising the benefits of early, family-centered developmental interventions rooted in the principles of enriched environments. Through a detailed clinical case involving a child with CDKL5-related developmental and epileptic encephalopathy (DEE), the thesis demonstrates that targeted early intervention programs can promote neurodevelopment and mitigate some of the severe impairments associated with DEEs and cerebral visual impairment. The third section addresses the hospital environment, investigating the effects of acoustic exposure in the NICU on the sleep architecture of preterm infants. A pilot longitudinal study conducted at Cambridge University Hospitals identified noise in the 4 kHz frequency band as particularly disruptive to neonatal sleep stability, which points to the importance of frequency-sensitive noise management strategies in critical care settings. Overall, the thesis highlights the dual vulnerability and plasticity of the developing brain, advocating integrative precision medicine approaches and climate-adapted healthcare strategies to optimise neurodevelopmental outcomes in at-risk paediatric populations. The results underscore the importance of early, targeted environmental interventions and support the need for multidisciplinary, anticipatory models in paediatric neurodevelopmental care.