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- W2147252337 abstract "A safe pharmacotherapeutic intervention is needed to mitigate neonatal brain injury resulting from perinatal asphyxia, stroke, or intracerebral hemorrhage. The ideal treatment would be readily available, relatively inexpensive, safe to use in preterm and term infants, require no special equipment, be effective with an acute regimen, be trophic in both neuronal and glial cells, and reduce cell loss by arresting both inflammatory and apoptotic cellular processes. A treatment meeting these criteria might be used globally to help reduce the estimated 920000 annual mortalities associated with perinatal asphyxia. The leading candidate under investigation is erythropoietin. Experimental data have thoroughly documented the neuroprotective actions of erythropoietin, and this cytokine is now being considered as a treatment for spinal cord injury,1 traumatic brain injury,2, 3 ischemic stroke,4 multiple sclerosis,5 and perinatal asphyxia.6However, these are challenging times for clinical erythropoietin neuroprotection research, because safety alerts reported to the US Food and Drug Administration (FDA) have delayed trials in the United States. Concerns about the safety of high-dose erythropoietin arose in September 2008, after increased mortality (16% erythropoietin vs 9% placebo) was reported for elderly patients after stroke who were given 3 daily doses of 40000 U of erythropoietin as part of a neuroprotection trial conducted in Germany. The risks of repeated erythropoietin exposure in adult patients may not apply to the preterm population, for whom the potential benefits may be profound. Nevertheless, 2 planned trials for erythropoietin neuroprotection in preterm infants are currently suspended by a blanket FDA hold (identifiers NCT00589953 and NCT00719407 [www.clinicaltrials.gov]). It is promising that 6 other trials are planned to evaluate the use of erythropoietin for neuroprotection in preterm infants (identifiers NCT00334737, NCT00413946, NCT00491413, and NCT00910234) and to protect against brain injury resulting from neonatal heart surgery (identifiers NCT00451698 and NCT00513240). Although safety data from a multicenter trial are still needed, it may be noted that 2 single-center trials to establish the pharmacokinetics and safety of neuroprotective doses of erythropoietin given to preterm infants have found no adverse consequences.7, 8In this issue of Pediatrics, Brown et al9 report on their analysis of 82 preterm infants, examined beyond 1 year of age (median: 25 months), to evaluate whether early erythropoietin exposure affects physical or mental development. To accomplish this goal, the authors reexamined a database that tracked outcomes in a population of infants born at ≤1500 g and ≤30 weeks' gestation. Previous analysis of this database documented an association between erythropoietin exposure and increased risk for retinopathy of prematurity.10 Brown et al now report that increasing cumulative erythropoietin exposure is also associated with improved Mental Developmental Index scores. This is significant, because these 2 analyses effectively weigh the benefits of early high-dose erythropoietin therapy against the risks by using a single population of preterm infants. This study is the first report that preterm infants treated with erythropoietin exhibit improved cognitive function, and these data support the rationale for prospective evaluation of erythropoietin for neonatal neuroprotection.In closing, given that >60% of low birth weight preterm infants survive and >36% of survivors are at high risk for developmental morbidities such as cerebral palsy and mental retardation (reviewed in ref 6), the development of a safe neuroprotective strategy for preterm infants would bring benefit to thousands of infants each year. Also, given that an FDA hold has suspended several prospective trials of high-dose erythropoietin, the retrospective analysis described by Brown et al provides data that further our understanding of the benefits of erythropoietin for the preterm population and support the argument that prospective research be permitted to proceed." @default.
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- W2147252337 date "2009-10-01" @default.
- W2147252337 modified "2023-09-26" @default.
- W2147252337 title "Can Erythropoietin Improve Developmental Outcomes for Preterm Infants?" @default.
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- W2147252337 doi "https://doi.org/10.1542/peds.2009-1853" @default.
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