Neuroprotective therapies in the NICU in term infants: present and future.
Eleanor J Molloy, Mohamed El-Dib, Sandra E Juul, Manon Benders, Fernando Gonzalez, Cynthia Bearer, Yvonne W Wu, Nicola J Robertson, Tim Hurley, Aoife Branagan, C Michael Cotten, Sidhartha Tan, Abbot Laptook, Topun Austin, Khorshid Mohammad, Elizabeth Rogers, Karen Luyt, Sonia Bonifacio, Janet S Soul, Alistair J Gunn, Newborn Brain Society Guidelines and Publications Committee
Pediatric research 2023 JunOutcomes of neonatal encephalopathy (NE) have improved since the widespread implementation of therapeutic hypothermia (TH) in high-resource settings. While TH for NE in term and near-term infants has proven beneficial, 30-50% of infants with moderate-to-severe NE treated with TH still suffer death or significant impairments. There is therefore a critical need to find additional pharmacological and non-pharmacological interventions that improve the outcomes for these children. There are many potential candidates; however, it is unclear whether these interventions have additional benefits when used with TH. Although primary and delayed (secondary) brain injury starting in the latent phase after HI are major contributors to neurodisability, the very late evolving effects of tertiary brain injury likely require different interventions targeting neurorestoration. Clinical trials of seizure management and neuroprotection bundles are needed, in addition to current trials combining erythropoietin, stem cells, and melatonin with TH. IMPACT: The widespread use of therapeutic hypothermia (TH) in the treatment of neonatal encephalopathy (NE) has reduced the associated morbidity and mortality. However, 30-50% of infants with moderate-to-severe NE treated with TH still suffer death or significant impairments. This review details the pathophysiology of NE along with the evidence for the use of TH and other beneficial neuroprotective strategies used in term infants. We also discuss treatment strategies undergoing evaluation at present as potential adjuvant treatments to TH in NE. © 2022. The Author(s).
Citation
Eleanor J Molloy, Mohamed El-Dib, Sandra E Juul, Manon Benders, Fernando Gonzalez, Cynthia Bearer, Yvonne W Wu, Nicola J Robertson, Tim Hurley, Aoife Branagan, C Michael Cotten, Sidhartha Tan, Abbot Laptook, Topun Austin, Khorshid Mohammad, Elizabeth Rogers, Karen Luyt, Sonia Bonifacio, Janet S Soul, Alistair J Gunn, Newborn Brain Society Guidelines and Publications Committee. Neuroprotective therapies in the NICU in term infants: present and future. Pediatric research. 2023 Jun;93(7):1819-1827
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PMID: 36195634
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