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Published on: April 21, 2017
Treatment advances in neonatal neuroprotection and neurointensive care
Michael V Johnston1, Ali Fatemi, Mary Ann Wilson
1Hugo W Moser Research Institute, at Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. Johnston@kennedykrieger.org
Insights
Moderate hypothermia effectively treats neonatal hypoxic-ischaemic encephalopathy (HIE). This neuroprotection strategy significantly improves survival rates and reduces long-term disability in newborns following asphyxia.
Area of Science:
- Neonatal neurology
- Neuroprotection strategies
- Asphyxia-related brain injury
Background:
- Neonatal hypoxic-ischaemic encephalopathy (HIE) involves a cascade of brain damage after asphyxia.
- Previous neuroprotection research lacked clinical evidence for HIE treatment.
- Understanding of HIE and neuroprotection has advanced significantly.
Purpose of the Study:
- To evaluate the clinical efficacy of moderate hypothermia in term infants with HIE.
- To assess the impact of hypothermia on survival and neurological outcomes.
- To explore advancements in neuroprotection for neonatal brain injury.
Main Methods:
- Three randomized controlled trials were conducted.
- Moderate hypothermia was administered within 6 hours of asphyxia.
- Outcomes measured included survival without cerebral palsy and neurological disability.
Main Results:
- Moderate hypothermia improved survival without cerebral palsy by approximately 40%.
- The treatment reduced death or neurological disability by nearly 30%.
- Clinical evidence now supports the efficacy of hypothermia for HIE.
Conclusions:
- Moderate hypothermia is a proven effective treatment for neonatal HIE.
- This neuroprotection approach significantly enhances outcomes for affected infants.
- Further research is exploring adjuvant therapies to augment hypothermia's benefits.
Abstract:
Knowledge of the nature, prognosis, and ways to treat brain lesions in neonatal infants has increased remarkably. Neonatal hypoxic-ischaemic encephalopathy (HIE) in term infants, mirrors a progressive cascade of excito-oxidative events that unfold in the brain after an asphyxial insult. In the laboratory, this cascade can be blocked to protect brain tissue through the process of neuroprotection. However, proof of a clinical effect was lacking until the publication of three positive randomised controlled trials of moderate hypothermia for term infants with HIE. These results have greatly improved treatment prospects for babies with asphyxia and altered understanding of the theory of neuroprotection. The studies show that moderate hypothermia within 6 h of asphyxia improves survival without cerebral palsy or other disability by about 40% and reduces death or neurological disability by nearly 30%. The search is on to discover adjuvant treatments that can further enhance the effects of hypothermia.
