What’s cool in neonatal hypoxic-ischaemic encephalopathy?

The field of neonatology has come a long way in the care of newborn infants, from the development of the first neonatal incubator and the Apgar scoring system to the modern day neonatology intensive care unit (NICU), which is fully equipped with temperature-controlled incubators, mechanical ventilators and other life-sustaining interventions for premature and term infants alike. Hypoxic-ischaemic encephalopathy (HIE) is a condition whereby the brain is deprived of adequate oxygen, therefore resulting in delayed cell death and devastating consequences for the developing neonatal brain. Through animal models, the pathophysiology of HIE is now increasingly being understood as an evolving process rather than a singular event. HIE is a major cause of neonatal morbidity and mortality, with only supportive treatment available until the development of therapeutic hypothermia in the early 21st century. Even with the implementation of therapeutic hypothermia as the standard of care, there are still major limitations with the treatment, most notably its partial efficacy. This review discusses what steps are currently being taken in the field to improve HIE outcomes, particularly adjuvant neuroprotective strategies such as erythropoietin (EPO) and stem cell therapy to be used in combination with therapeutic hypothermia, and the limitations facing HIE therapeutic development