Long-term pharmacologic neuroprotection after birth asphyxia: where do we stand?

Perinatal hypoxia-ischemia or birth asphyxia is a serious complication with a high mortality and morbidity. For decades, neuroprotective options have been explored to reduce reperfusion and reoxygenation injury to the brain, which accounts for a substantial part of birth asphyxia-related brain damage. In this review, we focus on neuroprotective strategies with a long-term follow-up, reported in both experimental and clinical studies. Strategies related to modification of excitatory neurotransmitter production and action, reduction in free radical production and inflammation and neoneurogenesis will be briefly summarized. Since hypothermia has been proven to be beneficial for a selected group of asphyxiated neonates, we assume that a combination of this treatment option with a pharmacological means of neuroprotection will be the appropriate approach in the future. Finally, it is important to consider possible gender effects in view of the discussed pharmacological strategies.