Prophylactic Recombinant Human Erythropoietin For Brain Injury In Preterm Infants

Objective:To investigate whether prophylactic erythropoietin(EPO)administration in high-risk preterm infants has neuroprotective effects,and whether it can reduce the incidence of early brain injury and the risk of later neurological dysfunction in preterm infants,and to evaluate the safety in a meta-analysis of randomized clinical trials(RCTs).Methods:According to PICOS principle,the data were retrieved from MEDLINE,EMBASE,Cochrane Central Register of Controlled Trials(Central),Nursing and Allied Health Literature(CINAHL)and China Biomedical Database(CBM)in May 2020.RCTs of EPO in the prevention and treatment of Brain injury in preterm infants(BIPI)were included.The quality of the included studies was evaluated by Cochrane Collaborating Tool.The rate of cerebral lesions,neurodevelopmental impairment and complications were combined and analyzed by Review Manager 5.3software.Results:Total of 12 articles(10 RCTs)including 2816 subjects were enrolled.Compared with placebo,incidence of PVL(RR(95%CI)=0.75[0.58,0.96],P<0.05)and MDI < 70(RR(95%CI)=0.67[0.45,0.99],P<0.05)significantly reduced in EPO group,and early EPO treatment significantly decreased rate of NEC(RR(95%CI)=0.71[0.56,0.90],P<0.05)and sepsis(RR(95%CI)=0.83[0.70,0.97],P<0.05),and it did not increased the risk of other serious diseases and adverse events(P > 0.05).Conclusion:Early prophylactic administration of EPO reduced the incidence of PVL and improved mental development in preterm infants.EPO can reduce the risk of septicemia and necrotizing enterocolitis in premature infants,and there is no significant difference in other serious adverse events.However,the conclusion of these large experiments are contradictory and the bias is high,so further studies are needed to define.