The management and prognostic implications of neonatal encephalopathy(NE)-an altered level of consciousness and abnormal tone and reflexes in term and near-term infants in the first days of life-depends on the underly...The management and prognostic implications of neonatal encephalopathy(NE)-an altered level of consciousness and abnormal tone and reflexes in term and near-term infants in the first days of life-depends on the underlying etiology[1].Since the most common cause of NE in the context of intrapartum hypoxia-ischemia(HI)is hypoxic-ischemic encephalopathy(HIE),the initial management.展开更多
Background Neonatal encephalopathy(NE)due to suspected hypoxic-ischemic encephalopathy(HIE),referred to as NESHIE,is a clinical diagnosis in late preterm and term newborns.It occurs as a result of impaired cerebral bl...Background Neonatal encephalopathy(NE)due to suspected hypoxic-ischemic encephalopathy(HIE),referred to as NESHIE,is a clinical diagnosis in late preterm and term newborns.It occurs as a result of impaired cerebral blood flow and oxygen delivery during the peripartum period and is used until other causes of NE have been discounted and HIE is confirmed.Therapeutic hypothermia(TH)is the only evidence-based and clinically approved treatment modality for HIE.However,the limited efficacy and uncertain benefits of TH in some low-to middle-income countries(LMICs)and the associated need for intensive monitoring have prompted investigations into more accessible and effective stand-alone or additive treatment options.Data sources This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE based on literatures from Pubmed and other online sources of published data.Results The underlining mechanisms of neurotoxic effect,current clinically approved treatment,various categories of emerging treatments and clinical trials for NE are summarized in this review.Melatonin,caffeine citrate,autologous cord blood stem cells,Epoetin alfa and Allopurinal are being tested as potential neuroprotective agents currently.Conclusion This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE.Neuroprotective agents are currently only being investigated in high-and middle-income settings.Results from these trials will need to be interpreted and validated in LMIC settings.The focus of future research should therefore be on the development of inexpensive,accessible monotherapies and should include LMICs,where the highest burden of NESHIE exists.展开更多
基金funded by the Gates Foundation[Grant Nos.INV-022216 and INV-041062]the South African Medical Research Council(SAMRC),and the University of Pretoria through the Institute for Cellular and Molecular Medicine.
文摘The management and prognostic implications of neonatal encephalopathy(NE)-an altered level of consciousness and abnormal tone and reflexes in term and near-term infants in the first days of life-depends on the underlying etiology[1].Since the most common cause of NE in the context of intrapartum hypoxia-ischemia(HI)is hypoxic-ischemic encephalopathy(HIE),the initial management.
基金supported by the South African Medical Research Council(GIPD 96783)the Bill and Melinda Gates Foundation(INV-022216 and INV-041062).
文摘Background Neonatal encephalopathy(NE)due to suspected hypoxic-ischemic encephalopathy(HIE),referred to as NESHIE,is a clinical diagnosis in late preterm and term newborns.It occurs as a result of impaired cerebral blood flow and oxygen delivery during the peripartum period and is used until other causes of NE have been discounted and HIE is confirmed.Therapeutic hypothermia(TH)is the only evidence-based and clinically approved treatment modality for HIE.However,the limited efficacy and uncertain benefits of TH in some low-to middle-income countries(LMICs)and the associated need for intensive monitoring have prompted investigations into more accessible and effective stand-alone or additive treatment options.Data sources This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE based on literatures from Pubmed and other online sources of published data.Results The underlining mechanisms of neurotoxic effect,current clinically approved treatment,various categories of emerging treatments and clinical trials for NE are summarized in this review.Melatonin,caffeine citrate,autologous cord blood stem cells,Epoetin alfa and Allopurinal are being tested as potential neuroprotective agents currently.Conclusion This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE.Neuroprotective agents are currently only being investigated in high-and middle-income settings.Results from these trials will need to be interpreted and validated in LMIC settings.The focus of future research should therefore be on the development of inexpensive,accessible monotherapies and should include LMICs,where the highest burden of NESHIE exists.
