Erythropoietin fails to decrease loss of life in neonates with neurologic situation

July 13, 2022

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Disclosures:
Please see the research for all authors’ related monetary disclosures.


Excessive-dose erythropoietin didn’t decrease the danger for loss of life amongst newborns present process therapeutic hypothermia for neonatal hypoxic ischemic encephalopathy, in response to research findings printed in The New England Journal of Medication.

The part 3 Excessive-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial additionally demonstrated that erythropoietin was linked to the next price of great opposed occasions in contrast with placebo.

Baby NICU
Excessive-dose erythropoietin didn’t decrease the danger for loss of life amongst newborns present process therapeutic hypothermia for hypoxic-ischemic encephalopathy. Supply: Adobe Inventory

The outcomes contradicted findings from smaller preclinical research that supported using erythropoietin, however they supported different research that discovered it was not neuroprotective.

“Neonatal hypoxic-ischemic encephalopathy refers to neurologic dysfunction ensuing from a discount of oxygen and blood move to a fetus’s mind close to the time of delivery and is a crucial reason for mind damage in time period and near-term infants,” the authors of the brand new research wrote.

They enrolled 501 infants in a double-blind, randomized, placebo-controlled trial and randomly assigned them between Jan. 25, 2017, by Oct. 9, 2019, to obtain both erythropoietin (1,000 U per kilogram of physique weight) or placebo, together with commonplace therapeutic hypothermia.

The infants had been from 23 U.S. hospitals and had been born at 36 weeks or extra of gestation with reasonable or extreme hypoxic–ischemic encephalopathy. Among the many 500 infants included within the modified intention-to-treat evaluation, 257 obtained erythropoietin and 243 obtained a placebo.

Amongst members included within the efficacy evaluation, loss of life or neurodevelopmental impairment at 22 to 36 months of age — the first consequence — occurred in 126 of 240 youngsters (52.5%) within the erythropoietin group and in 110 of 222 youngsters (49.5%) within the placebo group, for a RR of 1.03 (95% CI, 0.86-1.24).

Infants within the remedy group skilled the next imply variety of severe opposed occasions than infants the placebo group — 0.86 vs. 0.67 per youngster, for a RR of 1.26 (95% CI, 1.01 to 1.57).

“We discovered that a number of excessive doses of erythropoietin given with therapeutic hypothermia to time period and near-term new child infants with reasonable or extreme hypoxic-ischemic encephalopathy didn’t considerably have an effect on the incidence of loss of life or neurodevelopmental impairment at 2 to three years of age,” they wrote. “Moreover, infants who obtained erythropoietin had been extra more likely to have no less than one severe opposed occasion and had a better variety of severe opposed occasions than those that obtained placebo.”

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