Protecting the brain of term infants: from bench to bedside

Neonatal encephalopathy is a major cause of death and lifelong neurodisability. Until recently the only treatment option for infants suffering from hypoxic-ischaemic encephalopathy was supportive intensive care. Therapeutic hypothermia has been shown to reduce death and disability, and significantly increase the number of infants with normal neurodevelopmental outcome at 18 months of age. Its introduction into standard clinical practice follows over 20 years of research from basic experimental science through to multi-centre randomised controlled trials. Hypothermia should be achieved promptly, and active cooling methods during neonatal transport have been shown to reduce stabilization and transfer times to regional cooling centres. Cerebral function monitoring is an important tool to assess severity of injury and monitor seizures; magnetic resonance imaging provides the best early prognostic information. New adjunct therapies, such as inhaled xenon and melatonin, show promise and are currently in various stages of experimental and clinical evaluation.