ASPHYXIAL BRAIN-DAMAGE IN THE NEWBORN - NEW INSIGHTS INTO PATHOPHYSIOLOGY AND POSSIBLE PHARMACOLOGICAL INTERVENTIONS

New insights into the pathophysiology of the hypoxic-ischemic insult h ave opened the possibility of pharmacologic intervention in neonatal h ypoxic-ischemic encephalopathy. It is now known that many neurons surv ive a hypoxic-ischemic insult but remain dysfunctional for hours, with profound alterations in cell function. A cascade of biochemical alter ations occurs as a consequence of cellular ionic shifts, energy deplet ion, degradation of cell membrane phospholipids, and increased release of neurotransmitters. In addition, there are alterations in the metab olism of arachidonic acid and prostanoids and an excessive production of oxygen free radicals. The new therapeutic modalities are aimed at p reventing or arresting the biochemical changes that occur in the perio d after hypoxia-ischemia. This review details the biochemical alterati ons associated with neonatal hypoxic-ischemic encephalopathy and discu sses the possible use in newborns of pharmacologic agents currently un dergoing extensive investigations in experimental animals and adult hu mans.