Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; therapy ; Infant, Newborn ; Infant, Premature

China ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; therapy ; Infant, Newborn

Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; therapy ; Infant, Newborn ; Time Factors

Consensus ; Humans ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain/therapy* ; Infant, Newborn

Neonatal hypoxic-ischemic encephalopathy (HIE) is a common disease that affects brain function in neonates. At present, mild hypothermia and hyperbaric oxygen therapy are the main methods for the treatment of neonatal HIE; however, they are independent of each other and cannot be combined for synchronous treatment, without monitoring of brain function-related physiological information. In addition, parameter setting of hyperbaric oxygen chamber and mild hypothermia mattress relies on the experience of the medical practitioner, and the parameters remain unchanged throughout the medical process. This article proposes a new device for the treatment of neonatal HIE, which has the modules of hyperbaric oxygen chamber and mild hypothermic mattress, so that neonates can receive the treatment of hyperbaric oxygen chamber and/or mild hypothermic mattress based on their conditions. Meanwhile, it can realize the real-time monitoring of various physiological information, including amplitude-integrated electroencephalogram, electrocardiogram, and near-infrared spectrum, which can monitor brain function, heart rate, rhythm, myocardial blood supply, hemoglobin concentration in brain tissue, and blood oxygen saturation. In combination with an intelligent control algorithm, the device can intelligently regulate parameters according to the physiological information of neonates and give recommendations for subsequent treatment.
Infant, Newborn ; Humans ; Hypothermia, Induced/methods* ; Hypothermia/therapy* ; Hyperbaric Oxygenation ; Brain ; Electroencephalography ; Hypoxia-Ischemia, Brain/therapy*

Animals ; Animals, Newborn ; Brain ; Hypoxia-Ischemia, Brain/therapy* ; Mice ; Mice, Inbred ICR ; Moxibustion

Randomized controlled trials have demonstrated the safety and efficacy of mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE), which can reduce mortality or the incidence of severe neurological sequelae. Mild hypothermia has been used in the neonatal intensive care unit (NICU) as a routine treatment method for neonatal HIE in many developed countries, and it is increasingly applied in some NICUs in China. However, 40%-50% of the neonates treated with mild hypothermia die or develop severe neurological disability. Thus, to achieve the best neuroprotective effect, issues such as selection of patients with indications for mild hypothermia, cooling method, optimal time for mild hypothermia, duration of mild hypothermia, optimal target temperature, and the safety and long-term effects of mild hypothermia combined with other therapies, need to be further discussed. This article reviews the latest progress in clinical research on these issues.
Humans ; Hypothermia, Induced ; adverse effects ; methods ; Hypoxia-Ischemia, Brain ; therapy ; Infant, Newborn

Animals ; Humans ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain ; etiology ; therapy ; Infant, Newborn ; Randomized Controlled Trials as Topic

OBJECTIVEPharmacological intervention is an important means for the treatment of hypoxic-ischemic encephalopathy (HIE). As meta-analyses and randomized controlled clinical trials based on evidence-based medicine are able to provide the most reliable evidence for clinical practice, this study searched several databases in order to find the clinical evidence for the pharmacological treatment of neonatal HIE.

METHODSMeta-analyses and randomized (or quasi-randomized) controlled trials (RCT) for pharmacological therapy of HIE in term or late preterm newborn infants were searched from the databases of MEDLINE, EMBASE, Oxford Neonatal Group and Cochrane Library. The relevant literatures were statistically analyzed.

RESULTSFour Meta-analyses and thirteen RCTs were found to be involved in barbiturate, allopurinol, magnesium sulfate, mannitol, naloxone and dopamine therapy. None of the drugs could significantly decrease the mortality and the incidence of seizure or severe neurodevelopmental disabilities in newborn infants with HIE.

CONCLUSIONSCurrent clinical evidence indicates that no individual drug could decrease mortality and improve the neurodevelopmental outcomes in infants with HIE. Problems such as small scale in sampling and discrepancy in the identification of drug efficacy which exist in the clinical trials might lead to the uncertain effect of the drugs, and large sized and collaborative clinical trials are needed in the future.

Neonatal hypoxic-ischemic encephalopathy (HIE) remains one of the leading causes of death and long-term neurodevelopmental disorders in full-term neonates, and there is currently no curative treatment. Therapeutic hypothermia is now a standard therapy for HIE in the neonatal intensive care unit, but its safety and efficacy in remote areas remains unclear. Melatonin is an indole endocrine hormone mainly produced by the pineal gland and it has the ability to easily penetrate the blood-brain barrier. Through receptor and non-receptor mechanisms, melatonin exerts anti-oxidative and anti-inflammatory effects and participates in the regulation of organelle function and the inhibition of cell death. Melatonin is considered one of the most promising drugs for the treatment of HIE based on its reliable safety profile and clinical/preclinical results. This article reviews the recent research on the use of melatonin in combination with therapeutic hypothermia for the treatment of neonatal HIE.
Infant, Newborn ; Humans ; Melatonin/therapeutic use* ; Hypoxia-Ischemia, Brain/therapy* ; Hypothermia, Induced ; Intensive Care Units, Neonatal