Effect of early prophylactic low-dose recombinant human erythropoietin on retinopathy of prematurity in very preterm infants

Huiqing Sun, Juan Song, Wenqing Kang, Yong Wang, Xiantao Sun, Chongchen Zhou, Hong Xiong, Falin Xu, Mingchao Li, Xiaoli Zhang, Zengyuan Yu, Xirui Peng, Bingbing Li, Yiran Xu, Shan Xing, Xiaoyang Wang, Changlian Zhu, Huiqing Sun, Juan Song, Wenqing Kang, Yong Wang, Xiantao Sun, Chongchen Zhou, Hong Xiong, Falin Xu, Mingchao Li, Xiaoli Zhang, Zengyuan Yu, Xirui Peng, Bingbing Li, Yiran Xu, Shan Xing, Xiaoyang Wang, Changlian Zhu

Abstract

Background: Very preterm infants are at risk of developing retinopathy of prematurity (ROP). Recombinant human erythropoietin (rhEPO) is routinely used to prevent anemia in preterm infants; however, the effect of rhEPO on ROP development is still controversial. The purpose of this study was to evaluate the effect of early prophylactic low-dose rhEPO administration on ROP development in very preterm infants.

Methods: A total of 1898 preterm infants born before 32 weeks of gestation were included. Preterm infants received rhEPO (n = 950; 500 U/kg, rhEPO group) or saline (n = 948, control group) intravenously within 72 h of birth and then once every other day for 2 weeks.

Results: The total incidence of ROP was not significantly different between the two groups (10.2% vs. 13.2%, p = 0.055). Further analysis showed that rhEPO group had lower rates of type 2 ROP than the control group (2.2% vs. 4.1%, RR 0.98; 95% CI 0.96-1.00; p = 0.021). Subgroup analysis found that rhEPO treatment significantly decreased the incidence of type 2 ROP in infant boys (1.8% vs. 4.3%, p = 0.021) and in those with a gestational age of 28-296/7 weeks (1.1% vs. 4.9%, p = 0.002) and birth weight of 1000-1499 g (1.2% vs. 4.2%, p = 0.002). There was a small increasing tendency for the incidence of ROP in infants with a gestational age of < 28 weeks after rhEPO treatment.

Conclusions: Repeated low-dose rhEPO administration has no significant influence on the development of ROP; however, it may be effective for type 2 ROP in infant boys or in infants with gestational age > 28 weeks and birth weight > 1500 g. Trial registration The data of this study were retrieved from two clinical studies registered ClinicalTrials.gov (NCT02036073) on January 14, 2014, https://ichgcp.net/clinical-trials-registry/NCT02036073 ; and (NCT03919500) on April 18, 2019. https://ichgcp.net/clinical-trials-registry/NCT03919500 .

Keywords: Erythropoietin; Preterm infant; Retinopathy of prematurity.

Conflict of interest statement

We declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic flowchart shows the numbers of infants who were screened for eligibility, randomly assigned to the rhEPO or control group, and followed up to 45 weeks of corrected age. ROP, retinopathy of prematurity; NEC, necrotizing enterocolitis

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Source: PubMed

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