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

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

doi:10.1186/s12967-020-02562-y

Abstract

BackgroundVery 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.MethodsA 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.ResultsThe 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.ConclusionsRepeated 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 (NCT 02036073) on January 14, 2014, https://clinicaltrials.gov/ct2/show/NCT02036073; and (NCT03919500) on April 18, 2019. https://clinicaltrials.gov/ct2/show/NCT03919500.

Highlights

Very preterm infants are at risk of developing retinopathy of prematurity (ROP)
The baseline characteristics of the infants in the Recombinant human erythropoietin (rhEPO) and control groups were similar in terms of birth weight and gestational age (Table 1)
Effect of rhEPO on ROP Overall, there is a tendency of decreased incidence of ROP in the rhEPO group compared to that in the control group; the difference between the two groups was not statistically significant (10.2% vs. 13.2%, p = 0.055) (Table 2)

Summary

Introduction

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; 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. Anaemia of prematurity is common in preterm infants, especially in very preterm infants born at < 32 weeks of gestation [1]. Previous studies have shown that the early administration of rhEPO is effective in preventing anaemia, thereby reducing the need for red blood cell transfusion in preterm infants [6, 8, 9]

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