Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

Abstract

Background: Despite advances in clinical care, the incidence of bronchopulmonary dysplasia (BPD) remains high in premature infants. Erythropoietin (EPO) is used for the treatment of anemia of prematurity (AOP) to decrease blood transfusion needs. EPO has been shown to mobilize circulating endothelial progenitor cells and to enhance lung repair in animal models. Objective: To determine whether EPO treatment for AOP was associated with a reduced incidence of BPD in premature infants. Methods: This retrospective study was performed on all live-born neonates with birth weights from 500 to 1,500 g and gestational age (GA) from 22 to 32 weeks admitted from 1994 to 2002. Infants who received EPO and those who did not receive EPO were compared for incidence of BPD and other morbidities. Results: Of478 patients, 297 received EPO before 36 weeks’ postmenstrual age (group 1) and 181 did not receive EPO (group 2). Group 1 was of similar birth weight but lower GA than group 2. The incidence of BPD was lower in group 1 than group 2 (26 vs. 36%, p = 0.03); after adjusting for significant risk factors, the adjusted odds ratio for BPD was 0.50 (95% CI 0.32, 0.79), p = 0.0028. The BPD rate was much lower when EPO was initiated before 4 weeks of age (16%) as compared to later initiation (44%). Conclusions: This study shows an association between EPO treatment and reduced incidence of BPD in preterm infants, particularly when EPO treatment was initiated within the first 4 weeks of life.

Bronchopulmonary Dysplasia and Erythropoietin

“…Interestingly, data from our own unit provides support for the observations of Rayjada et al [1]. Between 2000 and 2007, we routinely used EPO in infants <28 weeks.…”

“…The observational study by Rayjada et al [1] demonstrated a reduction in bronchopulmonary dysplasia (BPD) in infants receiving erythropoietin (EPO). The study included a relatively large number of preterm infants at a single institution, presumably reducing inconsistency in terms of issues such as diagnosis of BPD.…”

Systemic endogenous erythropoietin and associated disorders in extremely preterm newborns

“…In preterm infants, neonatal rh-EPO drug treatment is associated with a decreased incidence of BPD,23 24 and a reduction of length of ventilation support 24. A protective effect of rh-EPO is also suggested in NEC pathogenesis where EPO enhanced the cell-cell barriers in epithelial cells in rats,25 and a lower incidence of NEC has been observed in newborns receiving rh-EPO 26.…”

Recombinant Human Erythropoietin Augments Angiogenic Responses in a Neonatal Rat Model of Cerebral Unilateral Hypoxia-Ischemia

“…Recently, it has been reported that EPO has many unexpected nonhematopoietic functions, including reducing the incidence of bronchopulmonary dysplasia [6], neuroprotection and angiogenesis [7]. Results of studies on injured prenatal brains have shown that neonatal rh-EPO administration is beneficial to myelination [8], rescues neural cells and induces lasting histological and functional improvements [9].…”