Citicoline effective in kids with hypoxic-ischemic encephalopathy

A new study published in the Italian Journal of Pediatrics suggests that citicoline has the potential to be a promising neuroprotective medication in newborns with hypoxic-ischemic encephalopathy (HIE). 

One of the biggest problems that might result in neonatal mortality or impairment is hypoxic-ischemic encephalopathy. As a result, Abeer Salamah and colleagues undertook this study to evaluate the impact of citicoline as a neuroprotector in infants with mild to severe HIE.

This study included 80 newborns with mild to severe HIE who were not eligible for therapeutic cooling. They were randomly separated into two groups: the citicoline treatment group, which comprised 40 newborns who received citicoline 10 mg / kg /12 h IV for 4 weeks along with additional supportive measures, and the control group, which included 40 neonates who got placebo along with the same supportive measures. All patients were assessed for the length of mechanical ventilation (MV), the necessity for inotropes, seizures, and NICU stay. After 4 weeks of therapy, all enrolled neonates had cranial ultrasounds and brain magnetic resonance imaging (MRI). All newborns were followed up on for neurodevelopmental outcomes at 3, 6, 9, and 12 months.

The key findings of this study were:

The number of newborns developing seizures after discharge was significantly lower in the citicoline-treated group (2 neonates) compared to the control group (11 neonates). 

At 4 weeks, the treatment group's cranial ultrasound and MRI results were much better than the control group's. 

Furthermore, neurodevelopmental outcomes in citicoline-treated neonates improved significantly at 9 and 12 months when compared to the control group. 

When compared to the control group, there was a statistically significant reduction in the length of seizures, NICU stay, inotrope usage, and MV in the treatment group. 

Citicoline was well tolerated and had no significant negative effects.

When compared to the control group, citicoline medication was related with a substantial reduction in seizures instances after discharge, NICU stay, inotrope usage, improvement in cranial ultrasound, MRI results, and neurodevelopmental outcome at 9 and 12 months.

Reference: 

Salamah, A., El Amrousy, D., Elsheikh, M., & Mehrez, M. (2023). Citicoline in hypoxic ischemic encephalopathy in neonates: a randomized controlled trial. In Italian Journal of Pediatrics (Vol. 49, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13052-023-01452-5