Within the first 28 days after birth, more than 1 in every 2500 newborns will suffer a stroke. The weekly-adjusted risk of stroke for a term-born infant is threefold higher than for a male smoker aged 50 to 59 years with hypertension and diabetes. Neonatal stroke has significant clinical and socio-economic consequences, leading to cerebral palsy, epilepsy, and a range of motor, sensory, and cognitive impairments. Currently, there is no treatment for the brain damage caused by neonatal stroke. In this review, we outline the differences in the complex interplay of inflammation, excitotoxicity, oxidative stress, and cell death after stroke between adults and neonates, which limits the direct transfer of knowledge between studies for understanding injury. We comprehensively document what is known about the pathophysiology of neonatal stroke and critically evaluate current therapeutic strategies, emphasising the urgent need for innovative treatments tailored to suit the neonatal brain. This analysis reveals that treatment with an injectable hydrogel scaffold, a three-dimensional, water-swollen polymer network, may be an innovative, viable approach to improve outcomes for infants suffering from the most severe forms of brain injury arising from neonatal stroke.

Neonatal stroke, occurring within the first 28 days after birth, affects >1 in every 2500 newborns. The weekly adjusted risk of stroke in a term newborn is 3-fold greater than for a male smoker aged 50 to 59 years with diabetes and hypertension. Neonatal stroke has profound clinical and socioeconomic implications, causing cerebral palsy, epilepsy, and various motor, sensory, and cognitive disabilities. Currently, there is no treatment for the brain damage that neonatal stroke causes. Hydrogels, with their tunable elasticity and stiffness, shear-thinning properties, and ability to deliver therapeutic agents locally in a controlled manner, offer significant potential for tissue repair and regeneration. In this review, we synthesize the current knowledge on biocompatible hydrogels, providing insights into how they can be engineered to address the pathophysiology of neonatal stroke and their previous use in repairing severe focal lesions in the adult central nervous system. By exploring cutting-edge hydrogel therapies, this review aims to provide a comprehensive perspective on the potential of hydrogel therapy to improve outcomes for infants suffering from severe brain injury due to neonatal stroke.

Background: Neonatal brain injuries such as stroke cause focal ischemic lesions that often result in lifelong neurological disabilities, as treatment options are limited. To speed up the discovery of potential therapies, early-phase screening with models that reliably reproduce brain injury, with scalable injury volume and minimal confounders, such as varying anaesthesia duration and painful procedures, is essential. Methods: Postnatal day 10 Sprague–Dawley rats of both sexes, with four litters per group and timepoint, were randomly allocated to delivery of intraperitoneal Rose Bengal (25, 40, or 60 mg/kg) and 10 minutes of light-emitting diode illumination through the intact scalp and skull. Infarct progression and reproducibility were assessed at 24 hours, 7 days, and 14 days post-injury. Outcomes included infarct volume and sensorimotor function, and cleaved caspase-3, glial fibrillary acidic protein (GFAP), and ionised calcium-binding adaptor molecule 1 (Iba1) immunoreactivity, with analysis of sex differences. Data were analysed using one-way or two-way ANOVA with Sidak’s post-hoc tests. Results: There was no mortality due to the infarct, and procedure time was approximately 19 minutes across all groups; the lesion was consistent and supported scalability. The 25 mg/kg dose produced a reproducible cortical infarct (3.74 ± 0.58 mm³; CV = 31%). Lesion size increased with dose and decreased over time (11.15 ± 0.63 mm³ at 60 mg/kg versus 0.05 ± 0.007 mm³ at 14 days; p < 0.0001). Cleaved caspase-3 and glial activation persisted for 14 days, indicating ongoing apoptosis and gliosis. No sex-dependent effects were observed in lesion volume, behaviour, or gliosis. Conclusions: This refined neonatal photothrombotic ischaemia model is reproducible, scalable, and ethically improved, requiring no skin incision. Its minimal surgical burden, absence of mortality, consistent histopathology, and measurable functional outcomes make it an ideal platform for preclinical screening of neuroprotective and reparative interventions in the developing brain.

Neonatal brain injuries, such as stroke, cause focal ischaemic lesions that often result in lifelong neurological disabilities, yet effective treatments remain limited. Early-phase therapeutic screening requires models that can reliably reproduce injury severity while minimising confounding variables, including prolonged or variable anaesthesia, surgical stress, and invasive procedures that themselves affect injury progression. Existing models of neonatal focal ischaemia often exhibit high mortality, technical complexity, and substantial variability in lesion location and volume. As a result, there is a critical need for a rapid, ethically refined, and scalable neonatal model that produces consistent cortical injury suitable for screening neuroprotective, biomaterial-based, and regenerative therapies. We established a minimally invasive photothrombotic ischaemia model in postnatal day 10 rats by administering intraperitoneal Rose Bengal (25, 40, or 60 mg/kg) and activating it with a fixed 10-minute exposure to 565-nm light through the intact scalp and skull. This incision-free protocol allowed a total procedure duration of 19 min. We characterized dose-dependent effects on infarct volume and anatomical distribution, cortical atrophy, ventricular enlargement, apoptosis (cleaved caspase-3), astrocytic and microglial reactivity (glial fibrillary acidic protein, GFAP; ionized calcium-binding adapter molecule 1, Iba1), and sensorimotor outcomes (wire hang, cylinder rearing, adhesive tape removal) at 1, 7, and 14 days after injury. Additional analyses assessed the reproducibility of lesion size across litters and explored sex-specific differences. A 25 mg/kg dose induced a reliable and well-localized motor cortex infarct with no mortality. Higher doses of Rose Bengal produced proportionally larger infarcts with greater subcortical involvement and more pronounced secondary atrophy. Across all groups, apoptotic signalling and glial reactivity remained elevated through 14 days, indicating persistent tissue injury. Sensorimotor impairments were robust at all stages, with deficits in forepaw use, endurance, and tactile response correlating with lesion volumes in the 25 mg/kg group. No significant sex differences were observed for any histological or behavioural outcomes. This refined neonatal photothrombotic model provides a reproducible, simple, scalable, and ethically optimized platform for inducing severe focal cortical injury. The model’s stable injury territory, short, standardized procedure, and consistent functional readouts fill a major gap in current research tools and provide a practical foundation for early-phase testing of neuroprotective and regenerative interventions.

Kynurenine pathway (KP) metabolite imbalance is implicated in perinatal brain injury, and KP metabolites are measured in human plasma and cerebrospinal fluid as markers of neuroinflammation. Methods validated in neonatal brain tissue or glial culture supernatant to the same standard are scarce, limiting comparisons across preclinical and clinical measurements. We optimised LC-MS/MS detection of tryptophan (TRYP), kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK), 3-hydroxyanthranilic acid (3-HAA), quinolinic acid (QA), anthranilic acid and picolinic acid after protein precipitation and Enhanced Matrix Removal-Lipid clean-up, validated it against Clinical and Laboratory Standards Institute (CLSI) acceptance criteria in brain tissue homogenate and cell culture supernatant, and applied it to a rat model of neonatal stroke and immune-activated BV2 microglia, reporting KYN/TRYP, KYNA/KYN, 3-HK/3-HAA and QA/KYNA ratios. The lower limit of quantification was 6.53-34.17 nM; imprecision was 0.57-11.47%, accuracy was 84.9-108.3%, recovery was 83.2-112.3%, and matrix effect was 87.8-108.8%, with linear calibration (R ² > 0.99) over 6.5-2000 nM. KYN/TRYP and QA/KYNA ratios were higher in the stroke hemisphere than in control brain at 1, 7 and 14 days (p<0.001), and KYNA/KYN was lower; lipopolysaccharide- and cytokine-stimulated BV2 microglia showed the same change in all four ratios (p<0.01). The assay quantifies eight KP metabolites and four pathway-balance ratios in brain tissue and microglial supernatant within clinical acceptance limits, allowing direct comparison with KP ratios reported in human plasma and cerebrospinal fluid. Changes in these ratios after neonatal stroke identify KYN/TRYP and QA/KYNA as candidate targets for neonatal biofluid studies.