Effects of Recombinant Human Erythropoietin Administration in Premature Infants with Severe Intraventricular Hemorrhage: A Single-Center Experience
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: We investigated the effects of early postnatal administration of erythropoietin (EPO) on neurodevelopmental outcomes and morbidities in preterm infants with severe grades of intraventricular hemorrhage (IVH). Methods: We retrospectively reviewed the medical records of preterm infants of gestational age 23+0 weeks to 31+6 weeks, who were diagnosed with severe grades of IVH and received EPO over at least 2 weeks. We compared clinical characteristics, major complications, and neurodevelopmental impairment between the two groups. The primary outcome was severe neurodevelopmental impairment at 18 to 26 months of corrected age. Severe neurodevelopmental impairment was defined as a mental developmental index or psychomotor developmental index of <70 on the Bayley Scales of Infant Development II or diagnosis of cerebral palsy. Results: The study included 33 preterm infants (mean gestational age 25.2±1.6 weeks and mean birth weight 775.1±224.5 g). EPO was administered at a dose of 400 or 1,000 IU/kg thrice weekly and was maintained over a mean period of 58.6± 25.9 days beginning from 10.7±6.9 days after birth. We observed no difference in perinatal characteristics between the EPO (n=14) and the control group (n=19). Similarly, severe neurodevelopmental impairment rates did not differ between the EPO (85.7%) and control groups (78.9%). The incidence of neonatal morbidities including bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity was also similar between the EPO and control groups. Conclusion: Early administration of EPO did not reduce the risk of severe neurodevelopmental impairment in preterm infants with severe IVH.
Abstract
Purpose: We investigated the effects of early postnatal administration of erythropoietin (EPO) on neurodevelopmental outcomes and morbidities in preterm infants with severe grades of intraventricular hemorrhage (IVH). Methods: We retrospectively reviewed the medical records of preterm infants of gestational age 23+0 weeks to 31+6 weeks, who were diagnosed with severe grades of IVH and received EPO over at least 2 weeks. We compared clinical characteristics, major complications, and neurodevelopmental impairment between the two groups. The primary outcome was severe neurodevelopmental impairment at 18 to 26 months of corrected age. Severe neurodevelopmental impairment was defined as a mental developmental index or psychomotor developmental index of <70 on the Bayley Scales of Infant Development II or diagnosis of cerebral palsy. Results: The study included 33 preterm infants (mean gestational age 25.2±1.6 weeks and mean birth weight 775.1±224.5 g). EPO was administered at a dose of 400 or 1,000 IU/kg thrice weekly and was maintained over a mean period of 58.6± 25.9 days beginning from 10.7±6.9 days after birth. We observed no difference in perinatal characteristics between the EPO (n=14) and the control group (n=19). Similarly, severe neurodevelopmental impairment rates did not differ between the EPO (85.7%) and control groups (78.9%). The incidence of neonatal morbidities including bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity was also similar between the EPO and control groups. Conclusion: Early administration of EPO did not reduce the risk of severe neurodevelopmental impairment in preterm infants with severe IVH.
참고문헌 (28)
- Jain NJ, "Impact of mode of delivery on neonatal complications : trends between 1997 and 2005", J Matern Fetal Neonatal Med, 22, pp.491~500 (2009)
- Singhi S, "Recent advances in perinatal neuroprotection", F1000Res, 8(F1000 Faculty Rev), pp.2031~ (2019)
- McNally MA, "Pharmacologic prevention and treatment of neonatal brain injury", Clin Perinatol, 46, pp.311~325 (2019)
- Victor S, "New possibilities for neuroprotection in neonatal hypoxicischemic encephalopathy", Eur J Pediatr, 181, pp.875~887 (2022)
- Noguchi CT, "Role of erythropoietin in the brain", Crit Rev Oncol Hematol, 64, pp.159~171 (2007)
- Kumral A, "the present and the future", Brain Dev, 33, pp.632~643 (2011)
- Brown MS, "Higher cumulative doses of erythropoietin and developmental outcomes in preterm infants", Pediatrics, 124, pp.e681~7 (2009)
- Fischer HS, "Prophylactic early erythropoietin for neuroprotection in preterm infants : a metaanalysis", Pediatrics, 139, pp.e20164317~ (2017)
- Song J, "Erythropoietin improves poor outcomes in preterm infants with intraventricular hemorrhage", CNS Drugs, 35, pp.681~690 (2021)
- Wu YW, "Erythropoietin for neuroprotection in neonatal encephalopathy : safety and pharmacokinetics", Pediatrics, 130, pp.683~691 (2012)
- Ohls RK, "or placebo", Pediatrics, 133, pp.1023~1030 (2014)
- Natalucci G, "Effect of early prophylactic high-dose recombinant human erythropoietin in very preterm infants on neurodevelopmental outcome at 2 years : a randomized clinical trial", JAMA, 315, pp.2079~2085 (2016)
- Song J, "Recombinant human erythropoietin improves neurological outcomes in very preterm infants", Ann Neurol, 80, pp.24~34 (2016)
- Ohls RK, "Neurodevelopmental outcome and growth at 18 to 22months’ corrected age in extremely low birth weight infants treated with early erythropoietin and iron", Pediatrics, 114, pp.1287~1291 (2004)
- Bierer R, "Erythropoietin concentrations and neurodevelopmental outcome in preterm infants", Pediatrics, 118, pp.e635~e640 (2006)
- Juul SE, "A randomized trial of erythropoietin for neuroprotection in preterm infants", N Engl J Med, 382, pp.233~243 (2020)
- Kellert BA, "A comparison of high-dose recombinant erythropoietin treatment regimens in braininjured neonatal rats", Pediatr Res, 61, pp.451~455 (2007)
- Gumy-Pause F, "Stepping up versus standard doses of erythropoietin in preterm infants : a randomized controlled trial", Pediatr Hematol Oncol, 22, pp.667~678 (2005)
- Whitelaw A, "Randomized clinical trial of prevention of hydrocephalus after intraventricular hemorrhage in preterm infants : brain-washing versus tapping fluid", Pediatrics, 119, pp.e1071~e1078 (2007)
- Luyt K, "Drainage, irrigation and fibrinolytic therapy (DRIFT) for posthaemorrhagic ventricular dilatation: 10-year follow-up of a randomised controlled trial", Arch Dis Child Fetal Neonatal Ed, 105, pp.466~473 (2020)
- Neubauer AP, "Erythropoietin improves neurodevelopmental outcome of extremely preterm infants", Ann Neurol, 67, pp.657~666 (2010)
- Aher SM, "Early versus late erythropoietin for preventing red blood cell transfusion in preterm and", or low birth weight infants, 2012, pp.10, CD004865~
- Chen J, "Erythropoietin deficiency decreases vascular stability in mice", J Clin Invest, 118, pp.526~533 (2008)
- Watanabe D, "Erythropoietin as a retinal angiogenic factor in proliferative diabetic retinopathy", N Engl J Med, 353, pp.782~792 (2005)
- Schmidt B, "Association between severe retinopathy of prematurity and nonvisual disabilities at age 5 years", JAMA, 311, pp.523~525 (2014)
- Ahn JH, "Neurodevelopmental outcomes in very low birthweight infants with retinopathy of prematurity in a nationwide cohort study", Sci Rep, 12, pp.5053~ (2022)
- Jensen EA, "Severity of bronchopulmonary dysplasia among very preterm infants in the United States", Pediatrics, 148, pp.e2020030007~ (2021)
- Anderson PJ, "Neurodevelopmental outcome of bronchopulmonary dysplasia", Semin Perinatol, 30, pp.227~232 (2006)