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Therapies for neonatal encephalopathy: Targeting the latent, secondary and tertiary phases of evolving brain injury.

Seminars in fetal & neonatal medicine
October 1, 2021
Aravanan A Chakkarapani et al. (10 authors)
Journal ArticleReviewHuman Study
Study Details

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

Extracted Claims (10)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
Anti-Inflammatory AgentsBrain InjuriesHumansHypothermia, InducedHypoxia-Ischemia, BrainInfant, NewbornInfant, Newborn, Diseases
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality80/10
Citation Metrics
Total Citations34
Citations/Year8.5
Relative Citation Ratio3.78
NIH Percentile89.3%
Research Impact Scores
APT Score0.95
Weight Score2.70
Normalized Score0.66
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