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Meta-Analysis
. 2021 Sep;41(9):2134-2140.
doi: 10.1038/s41372-021-01132-4. Epub 2021 Jun 26.

Erythropoietin monotherapy for neuroprotection after neonatal encephalopathy in low-to-middle income countries: a systematic review and meta-analysis

Phoebe Ivain  1 , Paolo Montaldo  2   3 , Aamir Khan  1 , Ramyia Elagovan  1 , Constance Burgod  1 , Maria Moreno Morales  1 , Stuti Pant  1 , Sudhin Thayyil  1
Affiliations
Meta-Analysis

Erythropoietin monotherapy for neuroprotection after neonatal encephalopathy in low-to-middle income countries: a systematic review and meta-analysis

Phoebe Ivain et al. J Perinatol. 2021 Sep.

Abstract

Objective: We examined whether erythropoietin monotherapy improves neurodevelopmental outcomes in near-term and term infants with neonatal encephalopathy (NE) in low-middle income countries (LMICs).

Methods: We searched Pubmed, Embase, and Web of Science databases to identify studies that used erythropoietin (1500-12,500 units/kg/dose) or a derivative to treat NE.

Results: Five studies, with a total of 348 infants in LMICs, were retrieved. However, only three of the five studies met the primary outcome of death or neuro-disability at 18 months of age or later. Erythropoietin reduced the risk of death (during the neonatal period and at follow-up) or neuro-disability at 18 months or later (p < 0.05). Death or neuro-disability occurred in 27.6% of the erythropoietin group and 49.7% of the comparison group (risk ratio 0.56 (95% CI: 0.42-0.75)).

Conclusion: The pooled data suggest that erythropoietin monotherapy may improve outcomes after NE in LMICs where therapeutic hypothermia is not available.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow chart of the literature search.
The diagram shows the different phases of the systematic review.
Fig. 2
Fig. 2. Forest plot of the observed effect of erythropoietin in the included studies.
Effect of erythropoietin on (A) death (neonatal period and at follow-up) or neuro-disability at 18 months of age or later, (B) cerebral palsy, and (C) death during the neonatal period and at follow-up (between three and 19 months of age) in infants with NE.
Fig. 3
Fig. 3. Risk of bias assessment.
(A) Risk of bias graph and (B) risk of bias summary.
See this image and copyright information in PMC

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