Neuroprotective strategies can prevent lesions from getting worse but agents that have neurotrophic properties can also affect repair in a developing brain. Although prevention and treatment in the early stages of brain lesions are desirable, delayed cell death or improved post-lesion plasticity are the only realistic targets in many cases. Several trophic factors can limit delayed cell death in animal models of perinatal brain damage. In addition, melatonin and brain-derived neurotrophic factor have been shown to promote post-lesion plasticity following neonatal excitotoxic white-matter damage in newborn mice. Despite these promising results, additional preclinical data are required for most of the trophic factors that have been tested, although some candidate drugs, e.g. melatonin or erythropoietin, might reach clinical trials in the near future.