Drugs for neuroprotection after birth asphyxia: Pharmacologic adjuncts to hypothermia

Abstract An adverse outcome is still encountered in 45% of full-term neonates with perinatal asphyxia who are treated with moderate hypothermia. At present pharmacologic therapies are developed to be added to hypothermia. In the present article, these potential neuroprotective interventions are desc...

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Bibliographic Details
Published in:Seminars in perinatology 2016-04, Vol.40 (3), p.152-159
Main Authors: Bel, Frank van, MD, PhD, Groenendaal, Floris, MD, PhD
Format: Article
Language:English
Subjects:
Asphyxia Neonatorum - complications
Asphyxia Neonatorum - metabolism
Asphyxia Neonatorum - physiopathology
Humans
Hypothermia
Hypothermia, Induced - adverse effects
Hypothermia, Induced - methods
Hypoxia-Ischemia, Brain - etiology
Hypoxia-Ischemia, Brain - metabolism
Hypoxia-Ischemia, Brain - prevention & control
Infant, Newborn
Metabolism
Neonatal and Perinatal Medicine
Neuroprotection - physiology
Neuroprotective Agents - pharmacology
Perinatal asphyxia
Pharmacologic neuroprotection
Term Birth
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Summary:Abstract An adverse outcome is still encountered in 45% of full-term neonates with perinatal asphyxia who are treated with moderate hypothermia. At present pharmacologic therapies are developed to be added to hypothermia. In the present article, these potential neuroprotective interventions are described based on the molecular pathways set in motion during fetal hypoxia and following reoxygenation and reperfusion after birth. These pathways include excessive production of excitotoxins with subsequent over-stimulation of NMDA receptors and calcium influx in neuronal cells, excessive production of reactive oxygen and nitrogen species, activation of inflammation leading to inappropriate apoptosis, and loss of neurotrophic factors. Possibilities for pharmacologic combination therapy, where each drug will be administered based on the optimal point of time in the cascade of destructive molecular reactions, may further reduce brain damage due to perinatal asphyxia.
ISSN:0146-0005
1558-075X
DOI:10.1053/j.semperi.2015.12.003