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Cool treatment for birth asphyxia, but what's next?
  1. Malcolm I Levene
  1. Academic Department of Paediatrics, D Floor, Clarendon Wing, Leeds General Infirmary, Leeds UK
  1. Correspondence to Prof MI Levene, Academic Department of Paediatrics, D Floor, Clarendon Wing, Leeds General Infirmary, Leeds LS2 9NS, UK; m.i.levene{at}leeds.ac.uk

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Recently published studies have confirmed that moderate hypothermia for 72 h after severe birth asphyxia reduces death and disability 1,,3 and the Treatment of Perinatal Asphyxial Encephalopathy (TOBY) study has also shown that the number of ‘normal’ infants surviving birth asphyxia at term is significantly increased by this treatment.3 In the UK most paediatricians appear to feel that hypothermia is now a standard of care for severely asphyxiated infants. Research into hypothermia was stimulated by increased understanding of the neurobiology of brain injury occurring after a global hypoxic-ischaemic insult. For a review of neonatal brain protection see Gressens.4 Despite the remarkable beneficial effects of hypothermia, improvement in subsequent outcome of asphyxiated babies is probably only improved by about 30% and it is likely that other neuroprotective therapies may add incrementally to the proven benefit of hypothermia. Indeed hypothermia may buy additional time for neuroprotective drugs to act within an expanded ‘therapeutic window’. This review article considers a number of potentially neuroprotective drugs on their ability to further improve outcome following birth asphyxia. Most are already licensed for use in children and are close to the point for further evaluation within randomised controlled trials in babies who receive therapeutic hypothermia as part of their routine management.

Erythropoietin

This naturally occurring glycoprotein is well known for its effect in stimulating erythropoeisis in the human neonate and is indeed used in a therapeutic setting to avoid neonatal anaemia.5 It has been shown that recombinant human erythropoietin (EPO) reduces the need for blood transfusions in very low birth weight babies when given after birth.

There is good evidence that EPO, a large molecule, crosses the blood brain-barrier by an active transport mechanism,6 although penetration may also occur as a result of damage to the blood brain-barrier following …

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