Kim Annink

165 Allopurinol: old drug, new indication in neonates? in over-treatment, since it is difficult to select the mothers with imminent fetal hypoxia. In contrast, postnatal allopurinol within 4 hours after birth might be too late because the oxygen radicals are formed shortly after birth. Consequently, very early postnatal allopurinol administration, i.e. immediately after resuscitation, might be the most effective mode of application. However, the efficacy of early allopurinol administration has not been investigated yet, neither has the combination of allopurinol and hypothermia been investigated previously in clinical or preclinical studies. Currently, a European double blinded, placebo-controlled, randomized controlled trial is designed in which 20mg/kg allopurinol intravenously will be administered immediately after or during resuscitation in asphyxiated babies. Neonates undergoing moderate hypothermia will receive a second dose of 10 mg/kg, 12 hours after birth. The primary endpoint will be death or impaired neurodevelopmental outcome at 2 years of age. Secondary endpoints are surrogate markers of brain injury on MRI, cerebral ultrasound, aEEG, multichannel EEG, plasma biomarkers and oxidative stress markers. This trial is essential to determine whether early allopurinol administration is a possible add-on neuroprotective therapy after perinatal asphyxia. ACKNOWLEDGMENTS We thank dr. Floris Groenendaal, neonatologist in the Wilhelmina Children’s Hospital, and Raymond Stegeman, PhD student in the Wilhelmina Children’s Hospital for carefully reviewing this paper. FUNDING We are grateful for a Horizon 2020 grant (HC2020-PHC18-2015-667224) that funds a new randomized controlled clinical trial investigating the effect of early allopurinol administration in HIE and fully funds the PhD position of Kim V. Annink. DISCLOSURES None of the authors have a conflict of interest to declare. 7