Effect of erythropoietin on cerebral palsy prevention in hypoxic-ischemic encephalopathy. Hemoglobin, C-reactive protein, caspase-3, and tumor necrosing factor-α levels

Context: Hypoxic ischemic encephalopathy (HIE) is one of the leading causes of cerebral palsy (CP) and neonatal mortality in developing countries. Erythropoietin (Epo) is one of the newest neuroprotective therapies to prevent cerebral palsy. Aims: To analyze the effect of Epo as a neuroprotective agent to prevent CP. Methods: A randomized, double-blind, placebo-controlled trial was conducted between January and October 2022 in the neonatology ward at a tertiary hospital in Surakarta, Indonesia. Twenty-five infants born at 32 weeks or more of gestation with HIE based on Thompson’s criteria were determined to receive Epo or placebo treatments. After their birth, as well as at 2, 3, 4, and 5 days of age, saline placebo or Epo (1000 IU per kilogram of body weight) was administered intravenously within 24 hours. Hemoglobin, c-reactive protein (CRP), caspase-3, and tumor necrosing factor-' (TNF-α) levels were measured both pre- and post-treatment. Neurological examination was performed at 2, 4, and 6 months of age to assess the occurrence of CP. Results: Hemoglobin and caspase-3 levels displayed an effect of Epo administration, in contrast with no significant difference found on CRP and TNF-a levels after the same treatment. However, the differences in the occurrence of cerebral palsy in the treatment group were statistically insignificant. Conclusion: Epo has significant neuroprotective effects on caspase-3 levels, but this is not enough to prevent CP.