Association Between Early Administration of High-Dose Erythropoietin in Preterm Infants and Brain MRI Abnormality at Term-Equivalent Age (vol 312, pg 817, 2014)

作者：Leuchter Russia Ha Vinh; Gui Laura; Poncet Antoine; Hagmann Cornelia; Lodygensky Gregory Anton; Martin Ernst; Koller Brigitte; Darque Alexandra; Bucher Hans Ulrich; Hueppi Petra Susan

来源：Journal of the American Medical Association, 2014, 312(8): A817-A817.

IMPORTANCE Premature infants are at risk of developing encephalopathy of prematurity, which is associated with long-term neurodevelopmental delay. Erythropoietin was shown to be neuroprotective in experimental and retrospective clinical studies.
OBJECTIVE To determine if there is an association between early high-dose recombinant human erythropoietin treatment in preterm infants and biomarkers of encephalopathy of prematurity on magnetic resonance imaging (MRI) at term-equivalent age.
DESIGN, SETTING, AND PARTICIPANTS A total of 495 infants were included in a randomized, double-blind, placebo-controlled study conducted in Switzerland between 2005 and 2012. In a nonrandomized subset of 165 infants (n = 77 erythropoietin; n = 88 placebo), brain abnormalities were evaluated on MRI acquired at term-equivalent age.
INTERVENTIONS Participants were randomly assigned to receive recombinant human erythropoietin (3000 IU/kg; n = 256) or placebo (n = 239) intravenously before 3 hours, at 12 to 18 hours, and at 36 to 42 hours after birth.
MAIN OUTCOMES AND MEASURES The primary outcome of the trial, neurodevelopment at 24 months, has not yet been assessed. The secondary outcome, white matter disease of the preterm infant, was semiquantitatively assessed from MRI at term-equivalent age based on an established scoring method. The resulting white matter injury and gray matter injury scores were categorized as normal or abnormal according to thresholds established in the literature by correlation with neurodevelopmental outcome.
Results At term-equivalent age, compared with untreated controls, fewer infants treated with recombinant human erythropoietin had abnormal scores for white matter injury (22% [17/77] vs 36% [32/88]; adjusted risk ratio [RR], 0.58; 95% CI, 0.35-0.96), white matter signal intensity (3% [2/77] vs 11% [10/88]; adjusted RR, 0.20; 95% CI, 0.05-0.90), periventricular white matter loss (18% [14/77] vs 33% [29/88]; adjusted RR, 0.53; 95% CI, 0.30-0.92), and gray matter injury (7% [5/77] vs 19% [17/88]; adjusted RR, 0.34; 95% CI, 0.13-0.89).
CONCLUSIONS AND RELEVANCE In an analysis of secondary outcomes of a randomized clinical trial of preterm infants, high-dose erythropoietin treatment within 42 hours after birth was associated with a reduced risk of brain injury on MRI. These findings require assessment in a randomized trial designed primarily to assess this outcome as well as investigation of the association with neurodevelopmental outcomes.

• 出版日期2014-8-27