Wachtel Elena V, Hendricks-Muñoz Karen D
Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY, USA.
Curr Probl Pediatr Adolesc Health Care. 2011 May-Jun;41(5):132-53. doi: 10.1016/j.cppeds.2010.12.002.
Neonatal encephalopathy after perinatal hypoxic-ischemic insult is a major contributor to global child mortality and morbidity. Brain injury in term infants in response to hypoxic-ischemic insult is a complex process evolving over hours to days, which provides a unique window of opportunity for neuroprotective treatment interventions. Advances in neuroimaging, brain monitoring techniques, and tissue biomarkers have improved the ability to diagnose, monitor, and care for newborn infants with neonatal encephalopathy as well as predict their outcome. However, challenges remain in early identification of infants at risk for neonatal encephalopathy, determination of timing and extent of hypoxic-ischemic brain injury, as well as optimal management and treatment duration. Therapeutic hypothermia is the most promising neuroprotective intervention to date for infants with moderate to severe neonatal encephalopathy after perinatal asphyxia and has currently been incorporated in many neonatal intensive care units in developed countries. However, only 1 in 6 babies with encephalopathy will benefit from hypothermia therapy; many infants still develop significant adverse outcomes. To enhance the outcome, specific diagnostic predictors are needed to identify patients likely to benefit from hypothermia treatment. Studies are needed to determine the efficacy of combined therapeutic strategies with hypothermia therapy to achieve maximal neuroprotective effect. This review focuses on important concepts in the pathophysiology, diagnosis, and management of infants with neonatal encephalopathy due to perinatal asphyxia, including an overview of recently introduced novel therapies.
围产期缺氧缺血性损伤后的新生儿脑病是全球儿童死亡和发病的主要原因。足月儿因缺氧缺血性损伤导致的脑损伤是一个复杂的过程，在数小时至数天内不断发展，这为神经保护治疗干预提供了一个独特的机会窗口。神经影像学、脑监测技术和组织生物标志物的进展提高了诊断、监测和护理新生儿脑病患儿以及预测其预后的能力。然而，在早期识别有新生儿脑病风险的婴儿、确定缺氧缺血性脑损伤的时间和程度以及最佳管理和治疗持续时间方面仍然存在挑战。治疗性低温是迄今为止对围产期窒息后患有中度至重度新生儿脑病的婴儿最有前景的神经保护干预措施，目前已被许多发达国家的新生儿重症监护病房采用。然而，每6名脑病患儿中只有1名能从低温治疗中受益；许多婴儿仍然会出现严重的不良后果。为了改善预后，需要特定的诊断预测指标来识别可能从低温治疗中受益的患者。需要开展研究来确定联合治疗策略与低温治疗的疗效，以实现最大的神经保护作用。本综述重点关注围产期窒息导致的新生儿脑病患儿的病理生理学、诊断和管理中的重要概念，包括对最近引入的新疗法的概述。
