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Neonatal encephalopathy due to suspected hypoxic ischemic encephalopathy:pathophysiology,current,and emerging treatments

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世界儿科杂志（英文版） 2024年第11期20卷 1105-1114页

作者： Carina Corte-Real Babbo Juanita Mellet Jeanne van Rensburg Shakti Pillay Alan Richard Horn Firdose Lambey Nakwa sithembiso christopher velaphi Gugulabatembunamahlubi Tenjiwe Jabulile Kali Melantha Coetzee Mogomane Yvonne Khomotso Masemola Daynia Elizabeth Ballot Michael Sean Pepper SAMRC Extramural Unit for Stem Cell Research and Therapy Department of ImmunologyFaculty of Health SciencesInstitute for Cellular and Molecular MedicineUniversity of PretoriaRoom 5-64Level 5Pathology Building15 Bophelo Road(Cnr.Steve Biko and Dr.Savage Streets)Prinshof CampusGezinaPretoriaSouth Africa Department of Paediatrics and Child Health Division of NeonatologyGroote Schuur HospitalUniversity of Cape TownNeonatal UnitCape TownSouth Africa Department of Paediatrics and Child Health Faculty of Health SciencesChris Hani Baragwanath Academic HospitalUniversity of the WitwatersrandJohannesburgSouth Africa Department of Paediatrics and Child Health Stellenbosch UniversityTygerberg Hospital Neonatal UnitCape TownSouth Africa Department of Paediatrics and Child Health Division of NeonatologyFaculty of Health SciencesSteve Biko Academic HospitalUniversity of PretoriaPretoriaSouth Africa Department of Paediatrics and Child Health Faculty of Health SciencesKalafong HospitalUniversity of PretoriaPretoriaSouth Africa Department of Paediatrics and Child Health Faculty of Health SciencesCharlotte Maxeke Johannesburg Academic HospitalUniversity of the WitwatersrandJohannesburgSouth Africa

Background Neonatal encephalopathy(NE)due to suspected hypoxic-ischemic encephalopathy(HIE),referred to as NESHIE,is a clinical diagnosis in late preterm and term *** occurs as a result of impaired cerebral blood flow and oxygen delivery during the peripartum period and is used until other causes of NE have been discounted and HIE is *** hypothermia(TH)is the only evidence-based and clinically approved treatment modality for ***,the limited efficacy and uncertain benefits of TH in some low-to middle-income countries(LMICs)and the associ-ated need for intensive monitoring have prompted investigations into more accessible and effective stand-alone or additive treatment options.Data sources This review describes the rationale and current evidence for alternative treatments in the context of the patho-physiology of HIE based on literatures from Pubmed and other online sources of published data.Results The underlining mechanisms of neurotoxic effect,current clinically approved treatment,various categories of emerg-ing treatments and clinical trials for NE are summarized in this ***,caffeine citrate,autologous cord blood stem cells,Epoetin alfa and Allopurinal are being tested as potential neuroprotective agents currently.Conclusion This review describes the rationale and current evidence for alternative treatments in the context of the patho-physiology of *** agents are currently only being investigated in high-and middle-income *** from these trials will need to be interpreted and validated in LMIC *** focus of future research should therefore be on the development of inexpensive,accessible monotherapies and should include LMICs,where the highest burden of NESHIE exists.

关键词： Brain Cerebrovascular circulation Hypoxia-ischemia Induced hypothermia Neuroprotective agents

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