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What can you do to protect the newborn brain?

Shea, Katherine Louisea; Palanisamy, Arvindb

Current Opinion in Anaesthesiology: June 2015 - Volume 28 - Issue 3 - p 261–266
doi: 10.1097/ACO.0000000000000184
OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Marc Van de Velde
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Purpose of review Hypoxic-ischemic brain injury is a leading cause of mortality and morbidity in neonates. Treating such injury by interrupting the excitotoxic-oxidative cascade is of immense importance. This review will focus on novel techniques of neuroprotection and describe the latest advances in established therapeutic methods.

Key findings Although the primacy of therapeutic hypothermia in treating hypoxic-ischemic encephalopathy is well established, recent research establishes that the arbitrarily chosen regimen of cooling to 33°C for 72 h may indeed be the most appropriate method. The optimal duration of antenatal magnesium therapy for neuroprotection remains unsettled, though it is reassuring that even 12 h or less of magnesium therapy results in comparable neurological outcomes. Combining adjuvant therapies such as melatonin or erythropoietin with therapeutic hypothermia results in favorable neurological outcomes compared with hypothermia alone. Finally, stem cell-based therapies show considerable potential in preclinical studies.

Summary Significant advances have occurred in the management of neonatal brain injury. With establishment of the optimal temperature and duration of hypothermia, combinatory therapies using adjuncts hold the greatest promise. Promising preclinical approaches such as stem cell-based therapy and use of noble gases need to be confirmed with clinical trials.

aClinical Fellow in Obstetric Anesthesia

bAssistant Professor of Anaesthesia, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Arvind Palanisamy, MD, FRCA, Department of Anesthesiology, Perioperative and Pain Medicine, CWN L1, Brigham and Women's Hospital, 75 Francis Street Boston, MA 02115, USA. Tel: +1 617 732 8220; fax: +1 617 264 6841; e-mail: apalanisamy@zeus.bwh.harvard.edu

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