The Impact of Erythropoietin Therapy in Neonatal Hypoxic–Ischemic Encephalopathy

A bstract Background: Erythropoietin (EPO) is a promising neuroprotective agent in hypoxic–ischemic encephalopathy (HIE). Objective: This study aimed to investigate the impact of EPO on neurodevelopmental outcomes in infants with HIE. Materials and Methods: One-hundred and forty infants (≥ 37 weeks’ gestation) with HIE were enrolled in the study according to inclusion criteria. All participants offered standard care according to the unit protocol. Infants were divided into two groups according to the use of EPO. The EPO group included 96 infants who received EPO, while the remaining 44 infants, who did not receive EPO, constituted the control group. Infants in the EPO group were administered 1000 U/kg of EPO on days 1, 2, 3, 5, and 7, starting within 24 h after birth. After discharge, all participants were followed-up to determine the primary outcome (death or neurodevelopmental impairment [NDI]) at the age of 24 months. Results: Ninety-six infants received EPO, and 44 infants did not. Only 52/140 (37.1%) infants received therapeutic hypothermia (TH), and 59% of patients with moderate-to-severe HIE (52/88) received TH. Patients in the EPO group showed significantly lower incidences of death or NDI at 24 months compared to the control group (16.6% vs. 50%, P = 0.023; odds ratio [OR], 0.07; 95% confidence interval [CI], 0.03–0.83; P = 0.038). Brain injury incidence was significantly lower in the EPO group (29.1% vs.77.2%, P = 0.007; OR, 0.19; 95% CI, 0.04−0.84; P = 0.039) than in the control group. Conclusion: EPO administration significantly improves the outcomes in infants with HIE and can be considered a promising neuroprotective agent for neonatal HIE.