| Objective: To explore the safety and efficacy of early application of recombinant erythropoietin(rEPO)to prevent necrotizing enterocolitis(NEC)in very low birth weight(VLBW)infants through a systematic review.Provide more evidence-based basis for clinical treatment.Method: Pubmed,Embase,Cochrane Library,CNKI,Wanfang,and VIP databases were searched for randomized controlled trials(RCTs)of early application of rEPO in very low birth weight infants.until December 2021.The literatures that met the inclusion and exclusion criteria were screened out,and the Cochrane risk of bias assessment tool was used to evaluate the quality and extract the required data.Data were analyzed using Revman 5.4 statistical software.Results: After preliminary literature search,a total of 1426 literatures were obtained,and14 literatures were finally included,with a total of 4647 very low birth weight infants.There were 2338 people in the rEPO treatment group and 2309 people in the control group.Meta-analysis results showed that the rEPO group could effectively reduce the incidence of NEC in very low birth weight infants(RR=0.75,[95%CI: 0.63,0.88],P=0.0006,and the incidence of stage ≥II(RR=0.75).0.76 [95%CI:0.62,0.94],P=0.01);however,the subgroup analysis of extremely low birth weight(ELBW)infants was not statistically significant(RR=1.01 [95%CI:0.55,1.86],P=0.96).Amongneurodevelopmental effects,the results showed a reduction in the incidence of intraventricular hemorrhage(IVH)(RR = 0.84,[95%CI: 0.74,0.96],P = 0.008),but Song et al.[1],the study had a great influence on the results.After exclusion,the results showed that the incidence of IVH could not be reduced(RR=0.91[95%CI:0.80,1.04],P=0.18).Other serious neurodevelopmental events such as mental development index(MDI)<70points(RR 0.58 [95%] CI: 0.27,1.27]),Blindness(RR=0.57,[95%CI:0.12,2.64],P=0.47),Hearing Loss(RR=0.77,[95%CI: 0.17,3.40],P=0.73)were not statistically significant;in terms of safety,rEPO treatment did not increase the risk of retinopathy of prematurity(ROP)in all stages(RR value=0.92,[95%CI: 0.83,1.02],P=0.10),subgroup analysis according to the severity of ROP,ROP stage I(RR=0.96,[95%CI: 0.59,1.54],P=0.85),ROP stage II(RR = 1.12,[95%CI: 0.39,3.24],P= 0.84),ROP stage III(RR 值=0.99,[95%CI:0.70,1.41],P=0.97),the results showed that rEPO doesn’t cause the incidence of ROP increased in each stage;the analysis results of the incidence of bronchopulmonary dysplasia(BPD)showed: RR value = 0.94,[95%CI: 0.82,1.09],P=0.44,no difference in the incidence of BPD.Impact,mortality analysis showed(RR =0.85,[95%CI: 0.71,1.03],P=0.09),had no effect on mortality,and the incidence of sepsis showed: RR value=0.91,[95%CI: 0.78,1.05],P=0.19,had no effect on sepsis,and did not shorten the length of hospital stay(MD=1.20,[95%CI:-4.23,6.63],P=0.66).Conclusion: rEPO can effectively reduce the incidence of NEC in very low birth weight infants at various stages,but cannot reduce the incidence of NEC in very low birth weight infants;it does not significantly reduce the incidence of mortality,sepsis,BPD,and does not significantly shorten the length of hospitalization;In terms of neurodevelopmental protective effects,in the analysis of intraventricular hemorrhage,the incidence ofintraventricular hemorrhage can be reduced,of which a single study[1]has a greater impact on the results,and its effect is questionable.There is no significant improvement in adverse events such as MDI <70 points,blindness,and hearing impairment,but it does not increase the incidence of ROP in each stage. |
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