Neonatal Hypoxic-Ischemic Encephalopathy: From the Limitations of Therapeutic Hypothermia to Precision Intervention
Abstract
Therapeutic hypothermia (TH) is the current standard of care for moderate-to-severe neonatal hypoxic-ischemic encephalopathy (HIE). However, its clinical application faces significant limitations, including a 44-55% rate of death or disability, a narrow 6‑h therapeutic window, inequitable global access, and inconsistent patient selection. These challenges highlight the need for emerging strategies that may complement or integrated with TH in the future. This review systematically synthesizes emerging therapeutic strategies beyond TH, encompassing four cutting-edge directions: first, targeting mitochondrial dysfunction and metabolic reprogramming; second, modulating neuroinflammation and immune responses; third, inhibiting programmed cell death pathways; and fourth, promoting neural repair and regeneration. We also discuss combination regimens, including sildenafil, resveratrol, and melatonin with magnesium, which have shown promise in preclinical or early clinical studies, while acknowledging that erythropoietin failed to show added benefit in Phase III trials. Importantly, most of the novel interventions discussed remain at preclinical or early‑phase clinical stages. To facilitate future translation, we systematically delineate the critical support infrastructure for HIE management in the precision medicine era: multimodal biomarkers and risk stratification, including neuroimaging, neuroelectrophysiology, fluid biomarkers, and clinical risk scoring models. By integrating…
Read the paper
Related studies
- 2024 update in heart failure
- Vascular involvement in idiopathic pulmonary fibrosis
- A novel technique- subendometrial autologous platelet rich plasma injection in patients with unresponsive thin endometrium undergoing frozen-thawed embryo transfer: a prospective cohort study
- Does metformin prolong pregnancy in preterm pre-eclampsia? A study protocol for a South African, hospital-based double-blind, randomised, placebo-controlled trial
- Combined Pulmonary Fibrosis and Emphysema (CPFE): A "New" Smoking-Related Interstitial Lung Disease (ILD)
- Impact of an acute 1-month cannabidiol treatment on pain and inflammation after a long bone fracture: a triple-blind randomised, placebo-controlled, clinical trial protocol
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.