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Nevroprotektiv behandling ved hypoksisk iskemisk encefalopati (HIE) hos nyfødte. Har allopurinol, Epo og melatonin en plass i behandlingen av HIE sammen med terapeutisk hypotermi?

Berg, Mie Marie
Master thesis
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Year
2020
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http://urn.nb.no/URN:NBN:no-79883

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  • Profesjonsstudiet medisin [1114]
Abstract
Background: Asphyxia and hypoxic ischemic encephalopathy (HIE) is globally an important cause of neonatal mortality and morbidity. Despite the established treatment with induced hypothermia, a significant proportion of children still die or suffer from severe neurodevelopmental disability. The pathogenesis and mechanisms of HIE are complex, and targeting these processes is essential to develope additive neuroprotective treatments. Allopurinol, Epo and melatonin are some of the drugs that are considered to be potentially neuroprotective. Objective: To examine the neuroprotective effects of allopurinol, Epo and melatonin in term- or near-term neonates that suffers from asphyxia and HIE. Method: This project is a literature review. A literature search was conducted in Medline, Embase and Cochrane library between March 2018 and January 2020. Source references in relevant review articles have also been examined. Keywords like asphyxia, asphyxia neonatorum, Hypoxia-Ischemia, Brain, hypoxic ischemic encephalopathy, allopurinol, Epo, melatonin were used in different combinations. Only clinical trials in English or Scandinavian languages were considered for inclusion. Results: 14 primary studies and one metaanalysis was included. Some of the studies show promising results in reducing mortality, morbidity and radiological/biochemical brain damage, but many of the studies are underpowered and the methodological quality is variable. Conclusion: Allopurinol, Epo and melatonin seem to have promising effects in the treatment of HIE. However, a definitive conclusion cannot be drawn from the limited amount of studies, and further research is needed. Several large, good quality RCT´s are ongoing, and these might provide an answear to whether the drugs have a clinical significant neuroprotective effect.
 
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