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Erythropoietin monotherapy for neuroprotection after neonatal encephalopathy in low-to-middle income countries: a systematic review and meta-analysis

Centre for Perinatal Neuroscience, Imperial College London, London, UK. Centre for Perinatal Neuroscience, Imperial College London, London, UK. p.montaldo@ic.ac.uk. Department of Neonatal Intensive Care, Universita degli Studi della Campania Luigi Vanvitelli, Naples, Italy. p.montaldo@ic.ac.uk.

Journal of perinatology : official journal of the California Perinatal Association. 2021;41(9):2134-2140
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PICO Summary

Population

Near-term and term infants with neonatal encephalopathy in low-middle income countries (5 studies, n= 348).

Intervention

Erythropoietin or one of its analogues.

Comparison

Placebo or usual care.

Outcome

Erythropoietin reduced the risk of death (during the neonatal period and at follow-up) or neuro-disability at 18 months or later. Death or neuro-disability occurred in 27.6% of the erythropoietin group and 49.7% of the comparison group (risk ratio 0.56).
Abstract
OBJECTIVE We examined whether erythropoietin monotherapy improves neurodevelopmental outcomes in near-term and term infants with neonatal encephalopathy (NE) in low-middle income countries (LMICs). METHODS We searched Pubmed, Embase, and Web of Science databases to identify studies that used erythropoietin (1500-12,500 units/kg/dose) or a derivative to treat NE. RESULTS Five studies, with a total of 348 infants in LMICs, were retrieved. However, only three of the five studies met the primary outcome of death or neuro-disability at 18 months of age or later. Erythropoietin reduced the risk of death (during the neonatal period and at follow-up) or neuro-disability at 18 months or later (p < 0.05). Death or neuro-disability occurred in 27.6% of the erythropoietin group and 49.7% of the comparison group (risk ratio 0.56 (95% CI: 0.42-0.75)). CONCLUSION The pooled data suggest that erythropoietin monotherapy may improve outcomes after NE in LMICs where therapeutic hypothermia is not available.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine