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Clinical studies note reduced activity of key antioxidant enzymes, such as glutathione (GSH) peroxidase (GPX) in SAE patients, highlighting the potential vulnerability of antioxidant systems in disease progression ( The antioxidant defense system, especially GSH metabolism, is linked to neurodegenerative diseases (Wu et al., 2004), but its role in SAE in incompletely defined

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Indeed, excessive ROS disrupt the BBB integrity, impairing its selective permeability (Hu et al., 2020)

Bioavailability: NAC has an oral bioavailability of approximately 6-10% due to extensive first-pass metabolism, but the deacetylated cysteine that reaches tissues effectively drives glutathione synthesis [9]

4), despite encouraging data regarding melatonin as an adjunctive treatment in neonatal disease, particularly in term infants with HIE