[Optimization of intensive therapy in neonatal hypoxic-ischemic encephalopathy]

Hypoxic-ischemic encephalopathy (HIE) due to perinatal asphyxia is a well-recognized clinical condition, marked by a relatively high early mortality rate (5–10%) and frequent late neurological complications (40%), including cerebral palsy, cognitive impairment, and learning difficulties in school-aged children in the Western world. Current guidelines recommend whole-body therapeutic hypothermia as a neuroprotective treatment for all neonates with moderate to severe HIE. While this intervention has improved outcomes, several critical aspects remain unresolved, making HIE a key focus of ongoing clinical research. This review gives a summary of our recent clinical studies conducted in this subject. These studies, focused on neonates with moderate to severe HIE, aimed to optimize intensive care in three key areas: (1) the feasibility and safety of controlled active hypothermia during transport; (2) the association between therapeutic hypothermia and hypocapnia, challenges in respiratory management, and the potential role of inhaled CO2 in enhancing neuroprotection; (3) hemodynamic instability, hypotension, relative adrenal insufficiency, and the therapeutic role of hydrocortisone. Orv Hetil. 2025; 166(38): 1483–1489.