New pharmacologic and therapeutic approaches for hypoxic-ischemic encephalopathy in the newborn.

Hypoxic-ischemic encephalopathy is still an important cause of neonatal mortality and long-term disabilities. The understanding of the differential responses to hypoxia-ischemia as an initial insult leading to cellular degeneration in brain has opened the way to develop new pharmacologic and therapeutic approaches. Due to the complex pathophysiology, therapies can target early pathways such as oxidative stress, inflammation and apoptosis or delayed pathways such as the privation of growth factors and cell death. Pharmacological interventions should start at different points of time according to their mechanisms of action. The association of moderate hypothermia with neuroprotective drugs may decrease cell injury and optimize endogenous repair. More basic science research focusing on the mechanisms of injury are required. Moreover, clinical trials are needed to detect safely and effectiveness drugs and to establish the optimal time of action for each one.