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Published on: October 28, 2022
Neuroprotection for hypoxic-ischemic encephalopathy: Contributions from the neonatal research network
Sonia Lomeli Bonifacio1, Lina F Chalak2, Krisa P Van Meurs1
1Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Insights
Therapeutic hypothermia (TH) is a proven neuroprotective treatment for neonatal encephalopathy due to hypoxic ischemic encephalopathy (HIE). Evidence from Neonatal Research Network trials confirms TH safety and efficacy, emphasizing its importance for eligible infants.
Area of Science:
- Neonatal Medicine
- Neuroprotection
- Perinatal Care
Background:
- Neonatal encephalopathy (NE) secondary to hypoxic ischemic encephalopathy (HIE) impacts infants born at or after 36 weeks gestation.
- Therapeutic hypothermia (TH) is the established standard of care for moderate to severe NE in high-income nations.
- The Neonatal Research Network (NRN) has been pivotal in advancing TH research.
Purpose of the Study:
- To review findings from three NRN trials on TH in term infants.
- To discuss secondary analyses informing HIE patient care.
- To highlight the established role of TH in neonatal neuroprotection.
Main Methods:
- Analysis of data from completed NRN TH trials in term infants (≥36 weeks gestation).
- Inclusion of data from other large TH trials to affirm safety and efficacy.
- Review of ongoing NRN randomized-controlled trial in preterm infants.
Main Results:
- Data affirm the safety and neuroprotective qualities of TH.
- TH is crucial for infants meeting criteria for HIE treatment.
- Ongoing research continues to refine TH protocols and applications.
Conclusions:
- Therapeutic hypothermia is a safe and effective neuroprotective strategy for neonatal encephalopathy.
- Consistent application of TH for eligible HIE infants is critical.
- Continued research, including NRN trials, advances understanding and implementation of TH.
Abstract:
Therapeutic hypothermia (TH) is now well established as the standard of care treatment for moderate to severe neonatal encephalopathy secondary to perinatal hypoxic ischemic encephalopathy (HIE) in infants ≥36 weeks gestation in high income countries. The Neonatal Research Network (NRN) contributed greatly to the study of TH as a neuroprotectant with three trials now completed in infants ≥36 weeks gestation and the only large randomized-controlled trial of TH in preterm infants now in the follow-up phase. Data from the first NRN TH trial combined with data from other large trials of TH affirm the safety and neuroprotective qualities of TH and highlight the importance of providing TH to all infants who qualify. In this review we will highlight the findings of the three NRN trials of TH in the term infant population and the secondary analyses that continue to inform the care of patients with HIE.
