Therapies for neonatal encephalopathy: Targeting the latent, secondary and tertiary phases of evolving brain injury.
Study Goal
The researchers aimed to evaluate Melatonin as a potential complementary therapy for neuroprotection and neurorestoration in neonates with neonatal encephalopathy following hypoxia-ischemia.
Results Summary
The abstract suggests Melatonin is a promising early/secondary phase therapy, likely due to its potential neuroprotective actions such as free radical scavenging, anti-apoptotic, or anti-inflammatory effects, but specific results are not detailed.
Population
Term and near-term neonates with neonatal encephalopathy.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
therapeutic hypothermia | increase | outcomes | term and near-term neonates with neonatal encephalopathy | - | well established | #1 |
Allopurinol | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #2 |
Azithromycin | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #3 |
Exendin-4 | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #4 |
Magnesium | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #5 |
Melatonin | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #6 |
Noble gases | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #7 |
Sildenafil | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #8 |
Erythropoietin | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #9 |
Stem cells | increase | neuroprotection | neonates with neonatal encephalopathy | - | promising | #10 |
In term and near-term neonates with neonatal encephalopathy, therapeutic hypothermia protocols are well established. The current focus is on how to improve outcomes further and the challenge is to find safe and complementary therapies that confer additional protection, regeneration or repair in addition to cooling. Following hypoxia-ischemia, brain injury evolves over three main phases (latent, secondary and tertiary), each with a different brain energy, perfusion, neurochemical and inflammatory milieu. While therapeutic hypothermia has targeted the latent and secondary phase, we now need therapies that cover the continuum of brain injury that spans hours, days, weeks and months after the initial event. Most agents have several therapeutic actions but can be broadly classified under a predominant action (e.g., free radical scavenging, anti-apoptotic, anti-inflammatory, neuroregeneration, and vascular effects). Promising early/secondary phase therapies include Allopurinol, Azithromycin, Exendin-4, Magnesium, Melatonin, Noble gases and Sildenafil. Tertiary phase agents include Erythropoietin, Stem cells and others. We review a selection of promising therapeutic agents on the translational pipeline and suggest a framework for neuroprotection and neurorestoration that targets the evolving injury.