Department of Psychiatry, Renmin Hospital of Wuhan University, Hubei Zhang Road (formerly Ziyang Road), Wuchang District No. 99, Jiefang Road 238, Wuhan, Hubei province, China.
Department of General Surgery, Renmin Hospital of Wuhan University, Hubei Zhang Road (formerly Ziyang Road), Wuchang District No. 99, Jiefang Road 238, Wuhan, Hubei province, China.
J Affect Disord. 2021 Mar 1;282:1187-1192. doi: 10.1016/j.jad.2021.01.018. Epub 2021 Jan 12.
The aim of this meta-analysis was conducted to assess the effects of different doses of prophylactic rhEPO on neurodevelopmental outcomes and provide reference for rational drug use. The primary outcome was the number of infants with a Mental Developmental Index (MDI) <70 on the Bayley Scales of Infant Development. Five RCTs, comprising 2282 infants, were included in this meta-analysis. Overall, prophylactic rhEPO administration reduced the incidence of infants with an MDI <70, with an odds ratio (95% confidence interval) of 0.55 (0.38-0.79), P <0.05. The low-dose rhEPO subgroup was superior to the placebo subgroup, with an OR (95% CI) of 0.47 (0.25-0.87), P <0.05. However, high-dose rhEPO subgroup had no significant impact on MDI <70 in infants <28 weeks' gestational age. The definitions of the secondary outcome showed that there was no significant effect of rhEPO on cerebral palsy. For neonatal complications, although four studies showed that there were no differences in the pooled results of BPD and ICH events between rhEPO treatment and placebo, the ICH events were significantly lower in the low-dose rhEPO (OR 0.36; 95% CI 0.23-0.59). In addition, in the pooled results of NEC and ROP events, there were significant differences between the two groups (OR 0.63; 95% CI 0.43-0.93) (OR 0.80; 95% CI 0.65-0.98). And the NEC events were significantly lower in the low-dose rhEPO (OR 0.45; 95% CI 0.27-0.73). Sustained low-dose prophylactic early erythropoietin might be more superior than high-dose for improvement of neurological outcomes and several neonatal complications in preterm infants.
本荟萃分析旨在评估不同剂量预防性 rhEPO 对神经发育结局的影响，为合理用药提供参考。主要结局是贝利婴幼儿发育量表（Bayley Scales of Infant Development）中精神发育指数（MDI）<70 的婴儿数量。该荟萃分析纳入了 5 项 RCT，共 2282 例婴儿。总体而言，预防性 rhEPO 给药降低了 MDI<70 的婴儿发生率，优势比（95%置信区间）为 0.55（0.38-0.79），P<0.05。rhEPO 低剂量亚组优于安慰剂亚组，优势比（95%CI）为 0.47（0.25-0.87），P<0.05。然而，rhEPO 高剂量亚组对 28 周胎龄以下婴儿的 MDI<70 无显著影响。次要结局的定义表明，rhEPO 对脑瘫无显著影响。对于新生儿并发症，虽然四项研究表明 rhEPO 治疗与安慰剂在 BPD 和 ICH 事件的汇总结果中无差异，但 rhEPO 低剂量组的 ICH 事件明显较低（OR 0.36；95%CI 0.23-0.59）。此外，在 NEC 和 ROP 事件的汇总结果中，两组之间存在显著差异（OR 0.63；95%CI 0.43-0.93）（OR 0.80；95%CI 0.65-0.98）。rhEPO 低剂量组 NEC 事件明显较低（OR 0.45；95%CI 0.27-0.73）。持续低剂量预防性早期促红细胞生成素可能比高剂量更优越，可改善早产儿的神经发育结局和几种新生儿并发症。
