Pharmacologic Prevention and Treatment of Neonatal Brain Injury

Clin Perinatol. 2019 Jun;46(2):311-325. doi: 10.1016/j.clp.2019.02.006. Epub 2019 Mar 26.

Abstract

Neonatal brain injury (NBI) remains a major contributor to neonatal mortality and long-term neurodevelopmental morbidity. Although therapeutic hypothermia is the only proven treatment to minimize brain injury caused by neonatal encephalopathy in term neonates, it provides incomplete neuroprotection. There are no specific drugs yet proven to prevent NBI in preterm neonates. This review discusses the scientific and emerging clinical trial data for several neuroprotective drugs in development, examining potential efficacy and safety concerns. Drugs with the highest likelihood of success and closest to clinical application include erythropoietin for term and preterm neonates and antenatal magnesium for preterm neonates.

Keywords: Erythropoietin; Hypoxic-ischemic encephalopathy; Magnesium; Neonatal brain injury; Neuroprotection; Periventricular leukomalacia; Therapeutic hypothermia.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Allopurinol / therapeutic use
  • Anesthetics, Inhalation / therapeutic use
  • Anticonvulsants / therapeutic use
  • Antioxidants / therapeutic use
  • Cerebral Intraventricular Hemorrhage / drug therapy
  • Cerebral Intraventricular Hemorrhage / prevention & control*
  • Cyclooxygenase Inhibitors / therapeutic use
  • Darbepoetin alfa / therapeutic use
  • Erythropoietin / therapeutic use
  • Free Radical Scavengers / therapeutic use
  • Hematinics / therapeutic use
  • Humans
  • Hypothermia, Induced
  • Hypoxia-Ischemia, Brain / drug therapy
  • Hypoxia-Ischemia, Brain / prevention & control*
  • Indomethacin / therapeutic use
  • Infant, Newborn
  • Leukomalacia, Periventricular / drug therapy
  • Leukomalacia, Periventricular / prevention & control*
  • Magnesium / therapeutic use
  • Melatonin / therapeutic use
  • Neuroprotection*
  • Prenatal Care
  • Topiramate / therapeutic use
  • Xenon / therapeutic use

Substances

  • Adrenal Cortex Hormones
  • Anesthetics, Inhalation
  • Anticonvulsants
  • Antioxidants
  • Cyclooxygenase Inhibitors
  • Free Radical Scavengers
  • Hematinics
  • Topiramate
  • Erythropoietin
  • Darbepoetin alfa
  • Xenon
  • Allopurinol
  • Magnesium
  • Melatonin
  • Indomethacin