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Neuroprotectieve behandelingsstrategieën na perinatale hypoxie-ischemie

  • Serie wetenschappelijk onderzoek
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Tijdschrift voor kindergeneeskunde

Summary

Perinatal hypoxia-ischemia is an important cause of neonatal mortality and morbidity (encephalopathy and mental retardation). A substantial part of the perinatal hypoxic-ischemic-related brain damage occurs upon and after reperfusion and reoxygenation by production of excitotoxic neurotransmitters and free radicals, by excessive nitric oxide production, cytokines release and a decrease in the endogenous production of growth factors. The presence of a so-called therapeutic window between the moment of hypoxia-ischemia and the start of cell death provides the opportunity to intervene both therapeutically as well as non-therapeutically. This article provides general information about the mechanisms that lead to brain damage following perinatal hypoxia-ischemia. Potential therapeutical interventions following perinatal hypoxia-ischemia are discussed, categorized to their mode of action. Furthermore, some non-therapeutical interventions are discussed, such as hypothermia and hyperbaric oxygen therapy. Well designed combinations of neuroprotective agents with non-therapeutical interventions should be given consideration in the treatment of post hypoxic-ischemic reperfusion injury of the newborn brain.

Samenvatting

Perinatale hypoxie-ischemie is een belangrijke oorzaak van neonatale mortaliteit en morbiditeit (spasticiteit en mentale retardatie). Een groot deel van de hierbij opgelopen hersenschade ontstaat gedurende en na reperfusie en reoxygenatie door de productie van exciterende neurotransmitters en vrije radicalen door overmatige stikstofmonoxideproductie, het vrijkomen van cytokinen en een afname in de endogene groeifactorenproductie. Het bestaan van een kritische tussenfase tussen het moment van hypoxie-ischemie en het optreden van celdood creëert mogelijkheden om zowel medicamenteus als niet-medicamenteus te interveniëren. Dit artikel geeft informatie over de mechanismen die leiden tot hersenschade na perinatale hypoxie-ischemie. Vervolgens wordt beknopt ingegaan op mogelijke medicamenteuze interventiestrategieën om de post-hypoxisch-ischemische reperfusieschade aan de hersenen te voorkomen of te reduceren. Ten slotte worden enkele niet-medicamenteuze interventies besproken, te weten hypothermie en het gebruik van hyperbare zuurstoftherapie. Een combinatie van medicamenteuze en niet-medicamenteuze interventies is het meest veelbelovend om neuroprotectie te kunnen bewerkstelligen na perinatale hypoxie-ischemie.

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    C. Peeters-Scholte

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  1. C. Peeters-Scholte
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  2. F. Groenendaal
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  3. F. van Bel
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Correspondence to C. Peeters-Scholte.

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Mw.dr. Cacha Peeters-Scholte, afdeling Neonatologie, Wilhelmina Kinderziekenhuis, Universitair Medisch Centrum Utrecht.Correspondentieadres: Prof.dr. F. van Bel, afdeling Neonatologie, KE04.123.1, Wilhelmina Kinderziekenhuis, Universitair Medisch Centrum, Postbus 85090, 3508 AB Utrecht, tel: 030-2504545, fax: 030-2505320

Dr. Floris Groenendaal, afdeling Neonatologie, Wilhelmina Kinderziekenhuis, Universitair Medisch Centrum Utrecht.

Prof.dr. Frank van Bel, afdeling Neonatologie, Wilhelmina Kinderziekenhuis, Universitair Medisch Centrum Utrecht.

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Peeters-Scholte, C., Groenendaal, F. & van Bel, F. Neuroprotectieve behandelingsstrategieën na perinatale hypoxie-ischemie. KIND 71, 98–103 (2003). https://doi.org/10.1007/BF03061437

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