Effect And Safety Of Different Doses Of Recombinant Human Erythropoietin On Treatment Of Brain Injury In Premature Infants

Objective:To investigate the efficacy and safety of different doses of recombinant human erythropoietin(rhEPO) on the treatment of brain injury in premature infants.Methods:From January 2012 to June 2014, 157 cases of premature infants diagnosed as brain damage by brain imaging in the neonatal intensive care unit of Affiliated Hospital of Jiangsu University were studied. Premature infants with brain injury were randomly divided into large, medium, small dose rhEPO group and control group. Large, medium and small rhEPO dose group were injected intravenously with rhEPO1000 U/kg, 750 U/kg, 500 U/kg for 3 days, The control group only received general treatment without injection of rhEPO. Enzyme linked immunosorbent assay(ELISA) was used to detect the levels of serum EPO and interleukin-6(IL-6) and central nervous specific protein B(S100B) in all groups before and after treatment with 24h;Neonatal behavioral neurological assessment(NBNA) was performed at 40 weeks of correct gestational age, the intelligent development assessment(CDCC)was performed at3, 6, and 9 months of correct gestational age, the mental development index(MDI) and motor development index(PDI) were measured.The changes of blood routine test, liver and renal function and retinopathy of prematurity(ROP), bronchial lung developmental dysplasia(BPD) disease occurrence situation were monitored before and after the treatment.Results:1. The concentration of EPO in the serum of each dose group increased with the increase of rhEPO.2. Compared with the control group, the contents of IL-6 and S100 B in the large and medium dose group were significantly lower than those in the controlgroup, the difference has statistically significant(P﹤0.05), there was no significant difference between the small dose group and the control group(P> 0.05);comparison of large, medium and small dose groups, the contents of IL-6 and S100 B in the large and medium dose group were significantly lower than those in the small group, the difference has statistically significant(P﹤0.05), there was no significant difference between the large dose group and the medium group(P> 0.05).3. Compared with the control group, the NBNA, PDI and MDI in the large and medium dose group were significantly higher than those in the control group, the difference has statistically significant(P﹤0.05), there was no significant difference between the small dose group and the control group(P> 0.05); comparison of large,medium and small dose groups, the NBNA, PDI and MDI in the large and medium dose group were significantly higher than those in the small group, the difference has statistically significant(P﹤0.05), there was no significant difference in the NBNA scores between the high dose group and the middle dose group(P > 0.05), but there were significant differences in the MDI scores at the age of June and in the MDI and PDI scores at the age of September between the high dose group and the middle dose group(P < 0.05), and the score increased with the increase of the dose.4. Before and after treatment, routine blood test including white blood cell count(WBC), red blood cell count(RBC), hemoglobin(Hb), platelet count(PLT)and liver and kidney function including alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN), creatinine(CR) were were measured, the results showed that there was no significant difference before and after treatment(P > 0.05).Conclusion:The neuroprotective effect of EPO on brain injury in preterm infants is related to the dose of rhEPO, high dose 1000U/kg rhEPO can significantly improveneurological outcome in preterm infants with brain injury,and in this dose range,rhEPO is safe and feasible for treatment of brain injury in preterm infants.