Abstract：Objective To evaluate the effect of early application of recombinant human erythropoietin (rhEPO) on white matter development in preterm infants using fractional anisotropy (FA) of magnetic resonance diffusion tensor imaging (DTI). Methods A total of 81 preterm infants with gestational age ≤ 32 weeks, birth weight < 1 500 g, and hospitalization within 24 hours after birth were randomly divided into rhEPO group (42 infants) and control group (39 infants). The infants in the rhEPO group were administered rhEPO, while those in the control group were given the same volume of normal saline. The preterm infants of both groups took examinations of head magnetic resonance imaging, diffusion-weighted imaging, and DTI at the corrected gestational age of 35-37 weeks. FA was calculated for the regions of interest in both groups. Results There was no significant difference in the incidence of intracranial hemorrhage, periventricular leukomalacia, focal cerebral white matter damage (CWMD), and extensive CWMD between rhEPO and control groups (P > 0.05). Compared with the control group, the rhEPO group showed higher FA values at the posterior limb of the internal capsule, the splenium of the corpus callosum, frontal white matter, and occipital white matter (P < 0.05). There was no significant difference in FA values at the parietal white matter, thalamus, lenticular nucleus, and caudate nucleus between the two groups (P > 0.05). Conclusions Early application of rhEPO has a neuroprotective effect on white matter development in preterm infants.
YANG Shu-Shuo,XU Fa-Lin,CHENG Hui-Qing et al. Effect of early application of recombinant human erythropoietin on white matter development in preterm infants[J]. CJCP, 2018, 20(5): 346-351.
Lawn JE, Blencowe H, Oza S, et al. Every newborn:progress, priorties, and potential beyond survival[J]. Lancet, 2014, 384(9938):189-205.
[2]
Zhao X, Chen Y, Qiu G, et al. Reducing preterm births in China[J]. Lancet, 2012, 380(9848):1144-1145.
[3]
Woodward LJ, Anderson PJ, Austin NC, et al. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants[J]. N Engl J Med, 2006, 355(7):685-694.
[4]
Juul S. Recombinant erythropoietin as a neuroprotective treatment:in vitro and in vivo models[J]. Clin Perinatol, 2004, 31(1):129-142.
[5]
van der Kooij MA, Groenendaal F, Kavelaars A, et al. Neuroprotective properties and mechanisms of erythropoietin in in vitro and in vivo experimental models for hypoxia/ischemia[J]. Brain Res Rev, 2008, 59(1):22-33.
[6]
Song J, Sun H, Xu F, et al. Recombinant human erythropoietin improves neurological outcomes in very preterm infants[J]. Ann Neurol, 2016, 80(1):24-34.
[7]
Pandit AS, Ball G, Edwards AD, et al. Diffusion magnetic resonance imaging in preterm brain injury[J]. Neuroradiology, 2013, 55(Suppl 2):65-95.
Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants[J]. Cochrane Database Syst Rev, 2006, 5(3):CD004863.
[14]
Zhu C, Kang W, Xu F, et al. Erythropoietin improved neurologic outcomes in newborns with hypoxic-ischemic encephalopathy[J]. Pediatrics, 2009, 124(2):e218-226.
[15]
Juul SE, Pet GC. Erythropoietin and neonatal neuroprotection[J]. Clin Perinatol, 2015, 42(3):469-481.
[16]
Juul S. Neuroprotective role of erythropoietin in neonates[J]. J Matern Fetal Neonatal Med, 2012, 25(4):105-107.
Arfanakis K, Haughton VM, Carew JD, et al. Diffusion tensor MR imagine in diffuse axonal injury[J]. AJNR Am J Neuroradiol, 2002, 23(5):794-802.
[19]
王淑霞. 3.0 T MRI、扩散加权成像和扩散张量成像在早产儿脑病的应用研究[D]. 武汉:华中科技大学, 2012.
[20]
Ling X, Tang W, Liu G, et al. Assessment of brain maturation in the preterm infants using diffusion tensor imaging (DTI) and enhanced T2 star weighted angiography (ESWAN)[J]. Eur J Radiol, 2013, 82(9):e476-483.
[21]
Robinson S, Li Q, Dechant A, et al. Neonatal loss of gammaaminobutyric acid pathway expression after human perinatal brain injury[J]. J Neurosurg, 2006, 104(6):396-408.
[22]
Back SA, Luo NL, Mallinson RA, et al. Selective vulnerability of preterm white matter to oxidative damage defined by F2-isoprostanes[J]. Ann Neurol, 2005, 58(1):108-120.
[23]
Liu W, Shen Y, Plane JM, et al. Neuroprotective potential of erythro-poietin and its derivative carbamylated erythropoietin in periventricular leukomalacia[J]. Experiment Neurol, 2011, 230(2):227-239.
[24]
O'Gorman RL, Bucher HU, Held U, et al. Tract-based spatial statistics to assess the neuroprotective effect of early erythropoietin on white matter development in preterm infants[J]. Brain, 2015, 138(Pt2):388-397.
[25]
Natalucci G, Latal B, Koller B, et al. Effect of early prophylactic high-dose recombinant human erythropoietin in very preterm infants on neurodevelopmental outcome at 2 Years:A randomized clinical trial[J]. JAMA, 2016, 315(19):2079-2085.
