Donna M. Ferriero, MD University of California San Francisco, Neonatal Brain Disorders Center, Box 0663, 521 Parnassus Avenue, C-215, San Francisco, CA 94143, USA.
Curr Treat Options Neurol. 2007 Nov;9(6):414-23. doi: 10.1007/s11940-007-0043-0.
Hypoxic-ischemic (HI) brain injury is the most common cause of encephalopathy and seizures in term newborn infants. There is no single, valid test for birth asphyxia leading to HI brain injury, and thus this disorder is often poorly characterized, and the timing and etiology of the injury can be difficult to ascertain. Optimal management of HI brain injury involves prompt resuscitation, careful supportive care including prevention of hyperthermia and hypoglycemia, and treatment of clinical and frequent or prolonged subclinical seizures. Recent evidence suggests that therapeutic hypothermia by selective head or whole-body cooling administered within 6 hours of birth reduces the incidence of death or moderate/severe disability at 12 to 22 months. Hypothermia is a promising new therapy that physicians should consider within the context of a registry or study. Optimal seizure treatment remains controversial because the most widely used drug, phenobarbital, has limited efficacy, and the value of monitoring and treating subclinical seizures is uncertain. There is compelling need for well-designed clinical trials to address treatment of ongoing brain injury in the setting of hypoxia-ischemia and seizures. Emerging evidence from preclinical studies suggests that future therapy for HI brain injury and neonatal encephalopathy will combine novel neuroprotective and anti-seizure agents. Pilot clinical trials of newer anticonvulsants are ongoing and will provide critical information for care of neonatal seizures.
缺氧缺血性（HI）脑损伤是足月新生儿脑病和癫痫发作的最常见原因。目前尚无单一有效的方法可以检测出导致 HI 脑损伤的窒息，因此这种疾病往往难以明确诊断，损伤的时间和病因也难以确定。HI 脑损伤的最佳治疗方法包括及时复苏、仔细的支持性护理，包括预防高热和低血糖，以及治疗临床和频繁或长时间的亚临床发作。最近的证据表明，在出生后 6 小时内通过选择性头部或全身冷却实施的治疗性低温可降低 12 至 22 个月时死亡或中度/重度残疾的发生率。低温是一种有前途的新疗法，医生应在注册或研究的背景下考虑使用。最佳的癫痫治疗方法仍存在争议，因为最广泛使用的药物苯巴比妥疗效有限，监测和治疗亚临床发作的价值也不确定。迫切需要精心设计的临床试验来解决缺氧缺血和癫痫发作情况下持续脑损伤的治疗问题。来自临床前研究的新证据表明，未来 HI 脑损伤和新生儿脑病的治疗将结合新型神经保护和抗癫痫药物。新型抗癫痫药物的临床试验正在进行中，将为新生儿癫痫的护理提供关键信息。
