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ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 2  |  Page : 45-52

Effect of erythropoietin as adjunctive therapy with whole-body cooling for treatment of hypoxic-ischemic encephalopathy in newborns


1 Pediatric Department, Division of Neonatology, Alexandria University Children’s Hospital, Alexandria, Egypt
2 Radiodiagnosis Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Correspondence Address:
Khalid M Saad
Pediatric Department, Division of Neonatology, University Children’s Hospital, Faculty of Medicine, Alexandria University, Alexandria, 21615
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJOP.AJOP_14_17

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Background Hypothermia induced by whole-body cooling (WBC) and/or selective head cooling reduces brain injury after hypoxia-ischemia in newborns. Despite differences in approach (head cooling vs. total body cooling), there is a general agreement that hypothermia improves outcomes of moderately asphyxiated infants, decreasing the combined outcome of death and neurologic dysfunction from 60 to 45%. Subsequently, the search for adjuvant therapies that may provide long-lasting neuroprotection was mandatory. Aim of the present work The present study aimed to evaluate the short-term effects of erythropoietin (Epo) as a neuroprotective agent in adjunction with WBC to treat newborn infants with hypoxic-ischemic encephalopathy (HIE). Participants and methods This is a true interventional randomized controlled hospital-based study. A total of 33 full-term and late preterm newborn infants, delivered at El-Shatby Alexandria University Maternity Hospital, Egypt, were enrolled in the study. They fulfilled the criteria of HIE and received WBC during the first 6 h of life, in addition to the standard intensive care measures. Of the 33 studied babies, 11 received 500 IU/kg Epo every other day for 2 weeks as adjunctive therapy to WBC. Results The Epo plus WBC group (group I) had a significantly shorter period of hospital stay in comparison with the other group managed by WBC solely (group II), [mean hospital stay in days±SD: 6.20±2.39 and 8.40±3.94, respectively (P=0.039)]. The incidence of seizures was insignificantly lower among babies in group I. Extensive white and gray matter brain lesions were observed more among group II neonates, although the difference was statistically insignificant. Clinical and neurological improvements, as guided by Thomson score, were better achieved among group I babies, despite the difference being statistically insignificant. Conclusion Epo as an adjunctive therapy with WBC for treating asphyxiated neonates is a safe mode of therapy, which significantly shortens the period of hospital stay as well as it (marginally) improves their short-term outcome, both radiologically and clinically. WBC plus Epo lowers the rate of occurrence of clinically detectable seizures in the 1st week of life among asphyxiated neonates.


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