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Progesterone as a Neuroprotective Agent in Neonatal Hypoxic-Ischaemic Encephalopathy: A Systematic Review
Ming-Te Lee1, Roisin McNicholas2, Lawrence Miall3
1Senior House Officer, Department of Neurosurgery, Leeds General Infirmary, Leeds, UK.
Developmental Neuroscience
|November 27, 2022
Summary
Progesterone (PROG) shows potential neuroprotection in newborn hypoxic-ischaemic encephalopathy (HIE) models, reducing brain damage and behavioral deficits. However, further high-quality research is needed to confirm efficacy and optimal use alongside therapeutic hypothermia (TH).
Area of Science:
- Neonatal neurology
- Neuroprotection research
- Pharmacological interventions
Background:
- Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of neonatal mortality and morbidity.
- Current standard treatment, therapeutic hypothermia (TH), benefits only a subset of newborns.
- Progesterone (PROG) exhibits potential neuroprotective mechanisms including anti-apoptotic and anti-inflammatory effects.
Approach:
- Systematic review of pre-clinical studies on progesterone for neonatal HIE.
- PICO framework used for study inclusion criteria (Population, Intervention, Comparison, Outcome).
- Searched Medline, EMBASE, and CINHAL databases; assessed risk of bias using SYRCLE tool.
Key Points:
- 14 studies included, most with high risk of bias.
- Progesterone demonstrated reduction in neuropathology (8 studies) and neurobehavioral deficits (3 studies) post-hypoxic-ischaemic insult.
- Observed sex dimorphism in progesterone's effects; limitations in study quality noted.
Conclusions:
- Progesterone shows promise as a therapeutic agent for neonatal HIE.
- Need for high-quality, large pre-clinical studies to determine optimal PROG dosage, timing, and safety.
- Future research could explore combining PROG with TH in large animal models.
