NDLI: New horizons for newborn brain protection: enhancing endogenous neuroprotection.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Hassell, K. Jane Ezzati, Mojgan Alonso-Alconada, Daniel Hausenloy, Derek J. Robertson, Nicola J.
Description	Country affiliation: United kingdom Author Affiliation: Hassell KJ ( Institute for Women's Health, University College London, London, UK.); Ezzati M ( Institute for Women's Health, University College London, London, UK.); Alonso-Alconada D ( Institute for Women's Health, University College London, London, UK.); Hausenloy DJ ( The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospital & Medical School, London, UK.); Robertson NJ ( Institute for Women's Health, University College London, London, UK.)
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.
File Format	HTM / HTML
ISSN	13592998
e-ISSN	14682052
DOI	10.1136/archdischild-2014-306284
Journal	Archives of Disease in Childhood - Fetal and Neonatal Edition
Issue Number	6
Volume Number	100
Language	English
Publisher	BMJ Publishing Group
Publisher Date	2015-11-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Pediatrics Discipline Perinatology Asphyxia Neonatorum Drug Therapy Hypothermia, Induced Hypoxia-ischemia, Brain Therapy Neuroprotection Drug Effects Neuroprotective Agents Therapeutic Use Brain Physiopathology Cannabinoids Adverse Effects Erythropoietin Infant, Newborn Melatonin Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pediatrics, Perinatology and Child Health Obstetrics and Gynecology

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Cool treatment for birth asphyxia, but what's next?

Synergistic neuroprotective therapies with hypothermia.

Erythropoietin and Neonatal Neuroprotection.

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New horizons for newborn brain protection: enhancing endogenous neuroprotection.

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