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New horizons for newborn brain protection: enhancing endogenous neuroprotection.

Archives of disease in childhood. Fetal and neonatal edition
November 1, 2015
K Jane Hassell et al. (5 authors)
Journal ArticleResearch Support, Non-U.S. Gov'tReviewHuman Study
Study Details

Study Goal

The researchers aimed to explore strategies, including melatonin, to augment endogenous neuroprotection in neonatal encephalopathy following hypoxic-ischaemic insults.

Results Summary

The abstract suggests melatonin is one of the interventions that can supplement the endogenous response to hypoxia-ischaemia to achieve full neuroprotective potential, alongside other therapies like therapeutic hypothermia and erythropoietin. However, specific results regarding melatonin's efficacy are not detailed.

Population

Infants with neonatal encephalopathy following hypoxic-ischaemic insults.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (6)
InterventionDirectionEndpointPopulationDosageImpactClaim #
Therapeutic hypothermia
neutral
NE
encephalopathic babies with sepsis or in those born following chorioamnionitis
-
is standard care
#1
remote ischaemic postconditioning
increase
endogenous brain tolerance
-
-
can activate
#2
Therapeutic hypothermia
neutral
the endogenous response to HI
-
-
can supplement
#3
melatonin
neutral
the endogenous response to HI
-
-
can supplement
#4
erythropoietin
neutral
the endogenous response to HI
-
-
can supplement
#5
cannabinoids
neutral
the endogenous response to HI
-
-
can supplement
#6
Abstract

Intrapartum-related events are the third leading cause of childhood mortality worldwide and result in one million neurodisabled survivors each year. Infants exposed to a perinatal insult typically present with neonatal encephalopathy (NE). The contribution of pure hypoxia-ischaemia (HI) to NE has been debated; over the last decade, the sensitising effect of inflammation in the aetiology of NE and neurodisability is recognised. Therapeutic hypothermia is standard care for NE in high-income countries; however, its benefit in encephalopathic babies with sepsis or in those born following chorioamnionitis is unclear. It is now recognised that the phases of brain injury extend into a tertiary phase, which lasts for weeks to years after the initial insult and opens up new possibilities for therapy.There has been a recent focus on understanding endogenous neuroprotection and how to boost it or to supplement its effectors therapeutically once damage to the brain has occurred as in NE. In this review, we focus on strategies that can augment the body's own endogenous neuroprotection. We discuss in particular remote ischaemic postconditioning whereby endogenous brain tolerance can be activated through hypoxia/reperfusion stimuli started immediately after the index hypoxic-ischaemic insult. Therapeutic hypothermia, melatonin, erythropoietin and cannabinoids are examples of ways we can supplement the endogenous response to HI to obtain its full neuroprotective potential. Achieving the correct balance of interventions at the correct time in relation to the nature and stage of injury will be a significant challenge in the next decade.

Medical Subject Headings (MeSH)
Asphyxia NeonatorumBrainCannabinoidsErythropoietinHumansHypothermia, InducedHypoxia-Ischemia, BrainInfant, NewbornMelatoninNeuroprotectionNeuroprotective Agents
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality80/10
Citation Metrics
Total Citations147
Citations/Year14.7
Relative Citation Ratio7.06
NIH Percentile96.1%
Research Impact Scores
APT Score0.95
Weight Score2.00
Normalized Score0.66
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