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World Journal of Pediatrics

Open Access 06-09-2024 | Erythropoietin | Review Article

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

Authors: 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

Published in: World Journal of Pediatrics

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Abstract

Background

Neonatal encephalopathy (NE) due to suspected hypoxic-ischemic encephalopathy (HIE), referred to as NESHIE, is a clinical diagnosis in late preterm and term newborns. It 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 confirmed. Therapeutic hypothermia (TH) is the only evidence-based and clinically approved treatment modality for HIE. However, the limited efficacy and uncertain benefits of TH in some low- to middle-income countries (LMICs) and the associated 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 pathophysiology 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 emerging treatments and clinical trials for NE are summarized in this review. Melatonin, 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 pathophysiology of HIE. Neuroprotective agents are currently only being investigated in high- and middle-income settings. Results from these trials will need to be interpreted and validated in LMIC settings. The 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.

Graphical abstract

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Metadata
Title
Neonatal encephalopathy due to suspected hypoxic ischemic encephalopathy: pathophysiology, current, and emerging treatments
Authors
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
Publication date
06-09-2024
Publisher
Springer Nature Singapore
Published in
World Journal of Pediatrics
Print ISSN: 1708-8569
Electronic ISSN: 1867-0687
DOI
https://doi.org/10.1007/s12519-024-00836-9