Long-term neuroprotective effects of allopurinol after moderate perinatal asphyxia: follow-up of two randomised controlled trials

Abstract

Objective Free-radical-induced reperfusion injury has been recognised as an important cause of brain tissue damage after birth asphyxia. Allopurinol reduces the formation of free radicals, thereby potentially limiting the amount of hypoxia-reperfusion damage. In this study the long-term outcome of neonatal allopurinol treatment after birth asphyxia was examined. Design Follow-up of 4 to 8 years of two earlier performed randomised controlled trials. Setting

Maternal allopurinol administration during suspected fetal hypoxia: a novel neuroprotective intervention? A multicentre randomised placebo controlled trial

“…Our recent follow-up study of two small prospective randomised controlled trials in neonates, investigating effects of postnatal allopurinol in asphyxiated neonates, showed beneficial effects of allopurinol on mortality and severe disabilities at 4–8 years of age in moderately asphyxiated neonates 35. Furthermore, maternal allopurinol treatment helped to maintain umbilical blood flow and reduced fetal cardiac oxidative stress after ischaemia-reperfusion in fetal sheep 10.…”

Recent Information on the Pathogenesis and Treatment of Hypoxic-Ischemic Brain Lesions in Newborns

“…Однако, увеличение количества участни-ков до 54 и более длительное наблюдение (до 5 лет) продемонстрировало положительный эффект примене-ния аллопуринола у новорожденных с умеренным ГИПП: тяжесть осложнений снизилась до 25% против 65 в груп-пе контроля [150]. Голландские исследователи объясняют неоднозначность первых результатов тем, что введение аллопуринола постнатально -слишком поздно для полу-чения клинически значимых антиоксидантных эффектов, поэтому в настоящее время они проводят клиническое исследование, где оцениваются эффекты антенаталь-ного введения препарата [151,152].…”

Nevroprotektiv behandling ved fødselsasfyksi

“…In these trials, allopurinol administered intravenously within two and four hours of birth in a total dose of 40 mg/kg did not result in a reduction in mortality, seizure frequency or number of pathological findings in cerebral imaging in the neonatal period. However, allopurinol treatment reduced the incidence of the combined outcome of death and severe handicap at the age of four to eight years when the children with the most severe asphyxia were excluded from the analysis (29). A clinical trial of antenatal allopurinol is in progress (30).…”