Neuroprotective therapies in the NICU in term infants: present and future.
Neuroprotective therapies in the NICU in term infants: present and future.
复制标题
DOI：
10.1038/s41390-022-02295-2
复制
发表时间：
2023-06
影响因子：
3.6
通讯作者：
Gunn, Alistair J.
中科院分区：
文献类型：
--
作者：
Molloy, Eleanor J.;El-Dib, Mohamed;Juul, Sandra E.;Benders, Manon;Gonzalez, Fernando;Bearer, Cynthia;Wu, Yvonne W.;Robertson, Nicola J.;Hurley, Tim;Branagan, Aoife;Michael Cotten, C.;Tan, Sidhartha;Laptook, Abbot;Austin, Topun;Mohammad, Khorshid;Rogers, Elizabeth;Luyt, Karen;Bonifacio, Sonia;Soul, Janet S.;Gunn, Alistair J.
新生儿脑病（NE）的结局已改善，因为广泛实施治疗性低温（TH）在高资源环境。虽然TH对足月和近足月婴儿的NE已被证明是有益的，但30-50%的中度至重度NE的婴儿用TH治疗仍然遭受死亡或显著损伤。因此，迫切需要找到其他药物和非药物干预措施，以改善这些儿童的结局。有许多潜在的候选者;然而，目前还不清楚这些干预措施是否有额外的好处时，与TH一起使用。虽然在HI后潜伏期开始的原发性和迟发性（继发性）脑损伤是神经功能障碍的主要因素，但三级脑损伤的晚期演变效应可能需要针对神经恢复的不同干预措施。癫痫发作管理和神经保护束的临床试验是必要的，除了目前的试验结合促红细胞生成素，干细胞，褪黑激素与TH。治疗性低温（TH）在新生儿脑病（NE）治疗中的广泛应用降低了相关的发病率和死亡率。然而，30-50%的患有中度至重度NE的婴儿用TH治疗仍然遭受死亡或显著损伤。这篇综述详细介绍了NE的病理生理学，沿着使用TH和其他用于足月儿的有益神经保护策略的证据。我们还讨论了治疗策略进行评估，目前作为潜在的辅助治疗TH在NE。
Outcomes of neonatal encephalopathy (NE) have improved since the widespread implementation of therapeutic hypothermia (TH) in high-resource settings. While TH for NE in term and near-term infants has proven beneficial, 30–50% of infants with moderate-to-severe NE treated with TH still suffer death or significant impairments. There is therefore a critical need to find additional pharmacological and non-pharmacological interventions that improve the outcomes for these children. There are many potential candidates; however, it is unclear whether these interventions have additional benefits when used with TH. Although primary and delayed (secondary) brain injury starting in the latent phase after HI are major contributors to neurodisability, the very late evolving effects of tertiary brain injury likely require different interventions targeting neurorestoration. Clinical trials of seizure management and neuroprotection bundles are needed, in addition to current trials combining erythropoietin, stem cells, and melatonin with TH. The widespread use of therapeutic hypothermia (TH) in the treatment of neonatal encephalopathy (NE) has reduced the associated morbidity and mortality. However, 30–50% of infants with moderate-to-severe NE treated with TH still suffer death or significant impairments. This review details the pathophysiology of NE along with the evidence for the use of TH and other beneficial neuroprotective strategies used in term infants. We also discuss treatment strategies undergoing evaluation at present as potential adjuvant treatments to TH in NE.
登录
查看更多内容
影响因子：
9.9
作者：
Boylan, GB;Rennie, JM;Binnie, CD
通讯作者：
Binnie, CD
影响因子：
6.3
作者：
Davidson, Joanne O.;Rout, Alexandra L.;Gunn, Alistair J.
通讯作者：
Gunn, Alistair J.
DOI：
10.1177/0271678x18776802
发表时间：
2018-08
期刊：
Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
影响因子：
--
作者：
Cunningham CJ;Redondo-Castro E;Allan SM
通讯作者：
Allan SM
影响因子：
8.3
作者：
Alonso-Alconada D;Broad KD;Bainbridge A;Chandrasekaran M;Faulkner SD;Kerenyi Á;Hassell J;Rocha-Ferreira E;Hristova M;Fleiss B;Bennett K;Kelen D;Cady E;Gressens P;Golay X;Robertson NJ
通讯作者：
Robertson NJ
影响因子：
10.3
作者：
Aridas, James DS.;Yawno, Tamara;Miller, Suzanne L.
通讯作者：
Miller, Suzanne L.