Novel interventions to reduce oxidative-stress related brain injury in neonatal asphyxia.
Study Goal
The researchers aimed to evaluate interventions, including melatonin, that could limit oxidative stress associated with hypoxic-ischemic encephalopathy in asphyxiated infants.
Results Summary
Melatonin was identified as a potential intervention targeting the acute injury phase of hypoxic-ischemic encephalopathy, alongside other treatments like allopurinol and noble gases. The abstract suggests it may help mitigate oxidative stress but does not provide specific efficacy data for melatonin alone.
Population
Asphyxiated infants with hypoxic-ischemic encephalopathy.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
limiting oxygen exposure | increase | outcomes of asphyxiated infants | asphyxiated infants | - | improved | #1 |
shortening the time to return of spontaneous circulation through improved methods for supporting hemodynamics and ventilation | increase | outcomes of asphyxiated infants | asphyxiated infants | - | improved | #2 |
Allopurinol | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the acute injury phase | #3 |
melatonin | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the acute injury phase | #4 |
noble gases such as xenon and argon | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the acute injury phase | #5 |
magnesium administration | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the acute injury phase | #6 |
Therapeutic hypothermia | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the subacute phase | #7 |
N-acetylcysteine2-iminobiotin | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the subacute phase | #8 |
remote ischemic postconditioning | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the subacute phase | #9 |
cannabinoids | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the subacute phase | #10 |
doxycycline | decrease | oxidative stress associated with hypoxic-ischemic encephalopathy | - | - | target the subacute phase | #11 |
Erythropoietin | decrease | injury in the repair phase after asphyxia | - | - | could potentially limit injury in the repair phase after asphyxia | #12 |
mesenchymal stem cells | decrease | injury in the repair phase after asphyxia | - | - | could potentially limit injury in the repair phase after asphyxia | #13 |
topiramate | decrease | injury in the repair phase after asphyxia | - | - | could potentially limit injury in the repair phase after asphyxia | #14 |
memantine | decrease | injury in the repair phase after asphyxia | - | - | could potentially limit injury in the repair phase after asphyxia | #15 |
therapeutic hypothermia | decrease | asphyxia-induced brain injury | - | - | is the only established treatment in the subacute phase of asphyxia-induced brain injury | #16 |
Perinatal asphyxia-induced brain injury may present as hypoxic-ischemic encephalopathy in the neonatal period, and disability including cerebral palsy in the long term. The brain injury is secondary to both the hypoxic-ischemic event and the reoxygenation-reperfusion following resuscitation. Early events in the cascade of brain injury can be classified as either inflammation or oxidative stress through the generation of free radicals. The objective of this paper is to present efforts that have been made to limit the oxidative stress associated with hypoxic-ischemic encephalopathy. In the acute phase of ischemia/hypoxia and reperfusion/reoxygenation, the outcomes of asphyxiated infants can be improved by optimizing the initial delivery room stabilization. Interventions include limiting oxygen exposure, and shortening the time to return of spontaneous circulation through improved methods for supporting hemodynamics and ventilation. Allopurinol, melatonin, noble gases such as xenon and argon, and magnesium administration also target the acute injury phase. Therapeutic hypothermia, N-acetylcysteine2-iminobiotin, remote ischemic postconditioning, cannabinoids and doxycycline target the subacute phase. Erythropoietin, mesenchymal stem cells, topiramate and memantine could potentially limit injury in the repair phase after asphyxia. To limit the injurious biochemical processes during the different stages of brain injury, determination of the stage of injury in any particular infant remains essential. Currently, therapeutic hypothermia is the only established treatment in the subacute phase of asphyxia-induced brain injury. The effects and side effects of oxidative stress reducing/limiting medications may however be difficult to predict in infants during therapeutic hypothermia. Future neuroprotection in asphyxiated infants may indeed include a combination of therapies. Challenges include timing, dosing and administration route for each neuroprotectant.