The impact of recombinant erythropoietin on neuro-developmental outcome in perinatal asphyxia

Background: Perinatal asphyxia is a leading cause of neonatal mortality, morbidity, and neurodevelopmental impairments. While therapeutic hypothermia is standard in high-income countries, it has not shown benefits in low- and middle-income settings. Alternative neuroprotective strategies, such as erythropoietin with its regenerative properties, are needed. This study evaluates the efficacy of recombinant erythropoietin in improving short-term neurodevelopmental outcomes in term neonates with moderate to severe hypoxic-ischemic encephalopathy. Methods: A randomized controlled trial was conducted at Bangladesh Shishu Hospital and Institute over two years, enrolling 88 neonates. Group A received standard treatment plus recombinant human erythropoietin (500 U/kg subcutaneously within 24 hours of birth, followed by daily doses for five days), while group B received standard care alone. Short-term outcomes, including seizure control, oral feeding tolerance, hospital stay, mortality, and neurodevelopment at discharge and three months, were assessed. Results: Both groups had comparable baseline characteristics. Group A had significantly faster seizure control (27.02±11.18 hours, p<0.001) and a lower need for multiple seizure drugs (20.5%, p=0.002). They also achieved full oral feeding earlier (8.50±1.54 versus 9.40±1.89 days, p=0.022). No significant differences were observed in hospital stay or mortality. Neurological abnormalities at discharge and three months were lower in group A (40.54% versus 70.59%; 23.5% versus 53.33%). Gross motor impairments were also significantly reduced (p=0.003). Conclusions: Erythropoietin improves short-term neurological outcomes in neonates with perinatal asphyxia, particularly when administered within 24 hours of birth.