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Erythropoietin for Hypoxic-Ischemic Encephalopathy: A Follow up Study in New Taipei City, Taiwan

Background: Perinatal asphyxia, intraventricular hemorrhage and stroke are common causes of neonatal brain injury, with hypoxia-ischemia as the final common pathway of injury. Epo has potential to lessen neurologic sequelae due to hypoxia-ischemia. Epo treatment for term infants with moderate hypoxic-ischemic encephalopathy (HIE) found reduced disability. The purpose of this study is to expand our understanding of Epo as a potential treatment for perinatal brain injury. Methods: We retrospectively reviewed the charts of 9 infants, from 2018 to 2022, clinically presenting with HIE due to fetal distress or perinatal insults. The first trial of Epo therapy for neuroprotection in term infants born > 37 weeks with moderate to severe hypoxic-ischemic encephalopathy (HIE) has now been completed. Epo-treated term babies received 1000 U/kg at day one, two, three, five and seven (D1, 2, 3, 5, 7) with the first dose administered by 48 hours of life. Results: Nine term newborns were enrolled. Epo treatment improved neurologic signs at 7 days, 12 months and 24 months as assessed by Bally, reduced disability for moderate HIE, decreased the overall number of cerebral palsy at 24 months of age. Consistent with trials of hypothermia for HIE, Epo was only effective for infants with moderate injury, and did not improve outcome for severely-affected infants. Conclusion: EPO is an effective agent to treat HIE. These eight term newborn has better results in both short-term and long-term outcomes. The result reveals clinical response to EPO therapy in 84.6% of patients within the first 2 months.