Erythropoietin is not a risk factor for severe retinopathy of prematurity among high risk preterm infants

Bui, Kevin; Ellenhorn, Naomi; Abbasi, Afshan; Villosis, Maria Fe; Nguyen, Marielle; Truong, Huy; Watson, Tameka; Buchanan, Joanna; Chen, Qiaoling

doi:10.1016/j.earlhumdev.2021.105440

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Previous results of the studies assessing the association between the erythropoietin use and risk of ROP were inconsistent and inconclusive [9][10][11][12][19][20][21]. A Cochrane systematic review in 2017 including 1283 eligible infants reported that early erythropoietin treatment before 8 days of age resulted in no signi cant difference in the risk of ROP (stage 3 and higher) between the two groups (RR 1.2 4 [95%CI 0.81-1.90]) [10].…”

Section: Discussionmentioning

confidence: 99%

“…Erythropoietin has an angiogenic effect on the retina, and animal studies reported that it might increase the risk of ROP [7,8]. Some previous human studies have reported an association between erythropoietin use and increased risk of ROP [9]; however, other studies found no associations [10][11][12]. These con icting ndings may be due to variations in the timing, duration, and dosage of erythropoietin and insu cient study sample sizes.…”

Section: Introductionmentioning

confidence: 99%

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Erythropoietin and retinopathy of prematurity: a retrospective cohort study in Japan, 2008–2018

Fukui,

Ito,

Kokubo

et al. 2024

J Perinatol

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Background: Retinopathy of prematurity (ROP) is a developmental retinal vascular proliferative disease and a leading cause of blindness in children worldwide. Erythropoietin has an angiogenic effect on the retina and might increase the risk of ROP. However, the results of previous studies on the association between erythropoietin use and increased risk of ROP have been inconsistent and inconclusive.Methods: This retrospective cohort study included infants born at 22 0/7 to 27 6/7 weeks' gestation between 2008 and 2018 who were admitted to neonatal intensive care units (NICUs) in the Neonatal Research Network of Japan. We compared mortality and morbidities during NICU stay between infants who received erythropoietin and those who did not.Results: Among 18 955 livebirth infants, this study included 16 031 infants, among which 14 373 infants (90%) received erythropoietin. The risk of ROP requiring treatment was signi cantly higher in the erythropoietin group than in the control group (33% vs. 26%;). The risk of chronic lung disease (CLD) was also signi cantly higher in the erythropoietin group (49% vs. 35%; aOR 1.60 ). On the other hand, the erythropoietin group had signi cantly lower risks of death before discharge, and necrotizing enterocolitis. The composite outcomes of "death or ROP" and "death or CLD" were not signi cantly different between the two groups.Conclusions: This study with a large sample size found that erythropoietin use was associated with increased risk of ROP requiring treatment and CLD, while being associated with reductions in deaths and

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Erythropoietin and retinopathy of prematurity: a retrospective cohort study in Japan, 2008–2018

Fukui,

Ito,

Kokubo

et al. 2024

J Perinatol

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“…We performed a multicenter retrospective study on infants born at < 32 weeks of gestation between January 1, 2018 and August 31, 2022 in 13 NICUs at Kaiser Permanente Southern California (KPSC). 16,17 We excluded infants with major congenital anomalies or those who were no longer Kaiser Permanente members by 6 months of corrected age due to mortality or member attrition. Additionally, we excluded infants lacking documented feeding information at 34 weeks PMA or missing data on feeding calories.…”

Section: Study Design Eligibility Criteria and Oversightmentioning

confidence: 99%

The impact of exclusive human milk diet on short-term growth of very preterm infants

Chou,

Zhang,

Nguyen

et al. 2024

Preprint

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Objectives: The impact of EHMD on postnatal growth remains controversial. This study aims to investigate the association between EHMD and short-term growth. Methods: This multicenter retrospective study aims to compare growth between the EHMD and non-EHMD groups among infants <32 weeks of gestation. Primary outcomes include weight, length, and head circumference growth trajectories between birth and 34 weeks postmenstrual age. Sensitivity and subgroup analyses were performed. Results: An EHMD was independently associated with poorer length growth, especially in infants born at ≥28 weeks’ gestation or those exposed to hypertensive disorders of pregnancy. While initiating fortification at <26 kcal/oz on an EHMD showed inferior growth, initiating fortification at ≥26 kcal/oz was associated with improved weight growth, and similar length and head circumference growth, when compared to the non-EHMD group. Conclusions: An EHMD with initial fortification at ≥26 kcal/oz may be implemented to avoid bovine milk exposure while sustaining comparable growth.

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“…One randomized clinical trial reported that low dose rhEPO intravenous treatment significantly decreased the incidence of retinopathy of prematurity, an effect of preterm hypoxia, in infant boys ( Sun et al, 2020 ), while many other studies focused on demonstrating that such oxidative damage was not related to EPO concentrations. ( Bui et al, 2021 ). Other clinical trials showed that EPO treatment was associated with a reduction in bronchopulmonary dysplasia, without considering the potential positive neurodevelopmental effects ( Rayjada et al, 2012 ; Bui et al, 2019 ).…”

Section: Improving Antioxidant Response Through Epo Administrationmentioning

confidence: 99%

Can Erythropoietin Reduce Hypoxemic Neurological Damages in Neonates With Congenital Heart Defects?

et al. 2021

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Congenital heart defects (CHD), the most common cause of birth defects with increasing birth prevalence, affect nearly 1% of live births worldwide. Cyanotic CHD are characterized by hypoxemia, with subsequent reduced oxygen delivery to the brain, especially critical during brain development, beginning in the fetus and continuing through the neonatal period. Therefore, neonates with CHD carry a high risk for neurological comorbidities, even more frequently when there are associated underlying genetic disorders. We review the currently available knowledge on potential prevention strategies to reduce brain damage induced by hypoxemia during fetal development and immediately after birth, and the role of erythropoietin (EPO) as a potential adjunctive treatment. Maternal hyper-oxygenation had been studied as a potential therapeutic to improve fetal oxygenation. Despite demonstrating some effectiveness, maternal hyper-oxygenation has proven to be impractical for extensive clinical application, thus prompting the investigation of specific pathways for pharmacological intervention. Among those, the role of antioxidant pathways and Hypoxia Inducible Factors (HIF) have been studied for their involvement in the protective response to hypoxic injury. One of the proteins induced by HIF, EPO, has properties of being anti-apoptotic, antioxidant, and protective for neurons, astrocytes, and oligodendrocytes. In human trials, EPO administration in neonates with hypoxic ischemic encephalopathy (HIE) significantly reduced the neurological hypoxemic damages in several reported studies. Currently, it is unknown if the mechanisms of pathophysiology of cyanotic CHD are like HIE. Neonates with cyanotic CHD are exposed to both chronic hypoxemia and episodes of acute ischemia-reperfusion injury when undergo cardiopulmonary bypass surgery requiring aortic cross-clamp and general anesthesia. Our review supports future trials to evaluate the potential efficiency of EPO in reducing the hypoxemic neurologic damages in neonates with CHD. Furthermore, it suggests the need to identify early biomarkers of hypoxia-induced neurological damage, which must be sensitive to the neuroprotective effects of EPO.

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Erythropoietin is not a risk factor for severe retinopathy of prematurity among high risk preterm infants

Cited by 5 publications

References 28 publications

Erythropoietin and retinopathy of prematurity: a retrospective cohort study in Japan, 2008–2018

Erythropoietin and retinopathy of prematurity: a retrospective cohort study in Japan, 2008–2018

The impact of exclusive human milk diet on short-term growth of very preterm infants

Can Erythropoietin Reduce Hypoxemic Neurological Damages in Neonates With Congenital Heart Defects?

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