Neonatal hypoxic ischaemic encephalopathy: Current and future treatment options

Introduction: Hypoxic ischaemic encephalopathy (HIE) remains a leading cause of mortality and long-term neurodevelopmental morbidities in neonates. Brain injury following HIE is a complex process that evolves over hours and days allowing a unique window of opportunity for therapeutic interventions. Over the past few years, therapeutic hypothermia has been shown to be beneficial for neuroprotection in the newborn and it is now a standard of treatment for HIE in the developed countries. It is likely that outcome can further improve when hypothermia is combined with other therapies.Areas covered: In this paper, we discuss hypothermia as the current neuroprotective measure for treatment along with the recent progress in some of the promising future therapies. We also discuss the difficulties faced in translation of basic science research into clinical trials.Expert opinion: With the complexity of the hypoxic ischaemic cascade it is likely that a combination of therapeutic agents will be needed, targeting different pathways to achieve adequate neuroprotection. Development of biomarkers will aid in providing evidence about safety and efficacy of treatment while long-term clinical data are being collected.