On the basis that similar biochemical and histological sequences of events occur in the brain during
thiamine deficiency and
hypoxia/
ischemia related brain damage, we have planned this review to discuss the possible therapeutic role of
thiamine and its derivatives in the management of neonatal
hypoxic-ischemic encephalopathy (HIE). Among the many benefits,
thiamine per se as
antioxidant, given intravenously (IV) at high doses, defined as dosage greater than 100 mg IV daily, should counteract the damaging effects of reactive
oxygen and
nitrogen species in the brain, including the reaction of
peroxynitrite with the
tyrosine residues of the major
enzymes involved in intracellular
glucose metabolism, which plays a key pathophysiological role in HIE in neonates. Accordingly, it is conceivable that, in neonatal HIE, the blockade of intracellular progressive oxidative stress and the rescue of mitochondrial function mediated by
thiamine and its derivatives can lead to a definite
neuroprotective effect. Because
therapeutic hypothermia and
thiamine may both act on the latent period of HIE damage, a synergistic effect of these therapeutic strategies is likely.
Thiamine treatment may be especially important in mild HIE and in areas of the world where there is limited access to expensive
hypothermia equipment.