ClemastineNeonatal White Matter Injury Trial (WRAP)

Inclusion Criteria:

1. Born at ≤32 weeks gestational age based on prenatal ultrasound or last menstrual period (LMP).
2. Current age of between 35-41 weeks PMA.
3. Imaging evidence of white matter injury on any scan as defined by either brain MRI or cUS criteria:

• Brain MRI with Grade Ib WMI or higher based on the Martinez-Biarge et al 2016 criteria.
• cUS with Grade 3 or higher white matter abnormalities based on Miller et al 2003 criteria.

4. Currently hospitalized in a participating intensive care nursery.

Exclusion Criteria:

1. Known or suspected metabolic or chromosomal disorder or major congenital anomalies
2. Major intracranial hemorrhage within the last 1 week or intracranial hemorrhage of any age that is not controlled or continuing to cause significant mass effect or midline shift.
3. History of cardiac arrhythmia or current ongoing tachycardia with baseline heart rate >10% age expected norms.
4. Hypotension requiring ongoing vasopressor or inotropic support.
5. Not able to receive enteral medications.
6. Clinically significant sedation due to critical illness or medications.
7. Concomitant use of any other putative neuroprotective or myelination promoting therapy as determined by the investigator.
8. Serum creatinine, aspartate aminotransferase (AST), or alanine aminotransferase (ALT) >2x the upper limit of normal for age.
9. Family history of epilepsy due to a confirmed or suspected genetic cause.
10. History of confirmed seizure activity.
11. If ≥36 weeks postmenstrual age, required respiratory support greater than 2L/min, noninvasive positive airway pressure, or mechanical ventilation upon reaching 36 weeks postmenstrual age due to diagnosis of moderate or severe BPD.
12. If less than 36 weeks postmenstrual age, currently requiring respiratory support greater than 2L/min, noninvasive positive airway pressure, or mechanical ventilation, unless respiratory support is being given to promote lung development and not due to clinical need.
13. Major medical conditions, laboratory abnormalities, or concurrent treatments that, in opinion of the investigator, may affect interpretation of study results or patient safety.