The Treatment of Neonatal Hypoxic-Ischemic Encephalopathy

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Developmental Neuroscience".

Deadline for manuscript submissions: closed (5 January 2019) | Viewed by 16109

Special Issue Editor


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Guest Editor
Perinatal Research Centre, UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
Interests: HIE; neuroprotection; neonatal seizures; GABA neurotransmission; BBB

Special Issue Information

Dear Colleagues,

I would like to invite you to contribute an article to an upcoming Special Issue of Brain Sciences that will focus on the treatment and management of neonatal brain injury. Despite active research and development of numerous promising therapies including hypothermia, translation to the clinical setting has moved slowly. This issue will highlight new strategies for neuroprotection including advances in the treatment of neonatal seizures (should we be treating them at all?). Attention to other mechanisms of injury including the blood-brain barrier, peripheral inflammatory contributions and neuroinflammation may provide alternative avenues for neuroprotection. Repurposing of currently approved drugs is also gathering momentum but do we need thorough pre-clinical testing in neonatal models or should we progress directly to clinical trials?

I look forward to your contributions to this exciting issue so that together we can progress this important field to improve neonatal brain outcomes.

Dr. Tracey Bjorkman
Guest Editor

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Keywords

  • HIE
  • Neuroprotection
  • Blood-brain barrier
  • EEG
  • Neonatal Seizures
  • Inflammation
  • IUGR

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Published Papers (2 papers)

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Review

13 pages, 1187 KiB  
Review
Haemodynamic Instability and Brain Injury in Neonates Exposed to Hypoxia–Ischaemia
by Shiraz Badurdeen, Calum Roberts, Douglas Blank, Suzanne Miller, Vanesa Stojanovska, Peter Davis, Stuart Hooper and Graeme Polglase
Brain Sci. 2019, 9(3), 49; https://doi.org/10.3390/brainsci9030049 - 27 Feb 2019
Cited by 29 | Viewed by 9436
Abstract
Brain injury in the asphyxic newborn infant may be exacerbated by delayed restoration of cardiac output and oxygen delivery. With increasing severity of asphyxia, cerebral autoregulatory responses are compromised. Further brain injury may occur in association with high arterial pressures and cerebral blood [...] Read more.
Brain injury in the asphyxic newborn infant may be exacerbated by delayed restoration of cardiac output and oxygen delivery. With increasing severity of asphyxia, cerebral autoregulatory responses are compromised. Further brain injury may occur in association with high arterial pressures and cerebral blood flows following the restoration of cardiac output. Initial resuscitation aims to rapidly restore cardiac output and oxygenation whilst mitigating the impact of impaired cerebral autoregulation. Recent animal studies have indicated that the current standard practice of immediate umbilical cord clamping prior to resuscitation may exacerbate injury. Resuscitation prior to umbilical cord clamping confers several haemodynamic advantages. In particular, it retains the low-resistance placental circuit that mitigates the rebound hypertension and cerebrovascular injury. Prolonged cerebral hypoxia–ischaemia is likely to contribute to further perinatal brain injury, while, at the same time, tissue hyperoxia is associated with oxidative stress. Efforts to monitor and target cerebral flow and oxygen kinetics, for example, using near-infrared spectroscopy, are currently being evaluated and may facilitate development of novel resuscitation approaches. Full article
(This article belongs to the Special Issue The Treatment of Neonatal Hypoxic-Ischemic Encephalopathy)
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26 pages, 347 KiB  
Review
Perinatal Hypoxic-Ischemic Encephalopathy and Neuroprotective Peptide Therapies: A Case for Cationic Arginine-Rich Peptides (CARPs)
by Adam B. Edwards, Ryan S. Anderton, Neville W. Knuckey and Bruno P. Meloni
Brain Sci. 2018, 8(8), 147; https://doi.org/10.3390/brainsci8080147 - 7 Aug 2018
Cited by 23 | Viewed by 6120
Abstract
Perinatal hypoxic-ischemic encephalopathy (HIE) is the leading cause of mortality and morbidity in neonates, with survivors suffering significant neurological sequelae including cerebral palsy, epilepsy, intellectual disability and autism spectrum disorders. While hypothermia is used clinically to reduce neurological injury following HIE, it is [...] Read more.
Perinatal hypoxic-ischemic encephalopathy (HIE) is the leading cause of mortality and morbidity in neonates, with survivors suffering significant neurological sequelae including cerebral palsy, epilepsy, intellectual disability and autism spectrum disorders. While hypothermia is used clinically to reduce neurological injury following HIE, it is only used for term infants (>36 weeks gestation) in tertiary hospitals and improves outcomes in only 30% of patients. For these reasons, a more effective and easily administrable pharmacological therapeutic agent, that can be used in combination with hypothermia or alone when hypothermia cannot be applied, is urgently needed to treat pre-term (≤36 weeks gestation) and term infants suffering HIE. Several recent studies have demonstrated that cationic arginine-rich peptides (CARPs), which include many cell-penetrating peptides [CPPs; e.g., transactivator of transcription (TAT) and poly-arginine-9 (R9; 9-mer of arginine)], possess intrinsic neuroprotective properties. For example, we have demonstrated that poly-arginine-18 (R18; 18-mer of arginine) and its D-enantiomer (R18D) are neuroprotective in vitro following neuronal excitotoxicity, and in vivo following perinatal hypoxia-ischemia (HI). In this paper, we review studies that have used CARPs and other peptides, including putative neuroprotective peptides fused to TAT, in animal models of perinatal HIE. We critically evaluate the evidence that supports our hypothesis that CARP neuroprotection is mediated by peptide arginine content and positive charge and that CARPs represent a novel potential therapeutic for HIE. Full article
(This article belongs to the Special Issue The Treatment of Neonatal Hypoxic-Ischemic Encephalopathy)
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