INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Majestic Complex (Posters 61-120) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #100 The Effectiveness of Erythropoietin in Treating Neonatal Hypoxic-Ischemic Encephalopathy: A Systematic Review and Meta-Analysis Aimee Wang, Columbia University Vagelos College of Physicians and Surgeons, Austin, United States Paul Lewis, Columbia University Vagelos College of Physicians and Surgeons, New York, United States Category: Prenatal/Perinatal Factors/Prematurity Keyword 1: child brain injury Keyword 2: hypoxia Keyword 3: perinatal factors Objective: Neonatal hypoxic-ischemic encephalopathy (HIE) is a neurological disorder that disrupts homeostatic functions and alters cognitive development. Treatments for this disease are limited. This systematic review and meta-analysis examines the effectiveness of erythropoietin in treating HIE. Participants and Methods: A systematic review was conducted following PRISMA guidelines using various iterations of keywords such as ‘erythropoietin,’ ‘treatment,’ and ‘neonatal hypoxic-ischemic encephalopathy’ in PubMed, Google Scholar, and Cochrane databases. A total of 14,400 articles were found from the keywords. These results were narrowed based on title and abstract, which yielded 1179 articles. Articles were excluded based on language (not in English), relevance (focused on diseases other than neonatal HIE), treatment type (in conjunction with other treatments), and study type (not a randomized controlled trial). 16 studies met the criteria and were included in the review. Studies gave the experimental group between 200 IU/kg to 3000 IU/kg of recombinant erythropoietin or erythropoietin intravenously and the control group a placebo saline solution, conventional treatment, or none of the above. Metrics of improvement were determined through the use of biomarkers (blood pressure, cerebral oxygenation, plasma levels) and index or behavioral assessment tests which assessed cognitive, language, motor, social-emotional, and adaptive skills. All study cohort sizes ranged from 40-501 participants; all of which were preterm infants with moderate to severe HIE. Results: Combining available participant data across included studies yielded 997 total participants for comparison. Within the meta-analysis, erythropoietin treatment for HIE failed to show significance compared to placebo (OR 1.12, 95% CI [0.88-1.44], p=0.36), The overall efficacy score obtained using the number of metrics across studies that showed improvement was approximately 63% with 10 out of 16 studies reporting improvement. There was heterogeneity within the pool of included studies (Chi2=15.56, I2=74%, p<0.01). For studies claiming improvement, mortality was significantly reduced in the erythropoietin-treated groups (p<0.05). Neurological changes such as the presence of cerebral palsy and disability also reported lower rates for the treatment groups (p<0.05). Most studies utilizing biomarkers reported no significant results through the measurement of blood pressure, cerebral oxygenation, hemoglobin count, plasma levels, or serum levels. Two studies, however, reported improvement through hematocrit and serum levels (p<0.05). All studies using the Neonatal Behavioral Neurological Assessment as its main metric of improvement reported significant improvement between the treatment and control group (p<0.05) and concluded long-term neurological improvement in the erythropoietin-treated group. Studies using the Bayley Scales of Infant Development, however, reported no statistically significant difference between the mean Mental Development Index scores of the two groups. Conclusions: The comparisons of the studies yielded varying results with numerous discrepancies. While meta-analysis failed to show significance for treatment, the significant heterogeneity may indicate a role in certain cases or populations. To determine the effectiveness of erythropoietin as a treatment for HIE, an expansion and diversification of research concerning erythropoietin treatment for neonates is warranted to provide a conclusive and holistic evaluation of the efficacy of erythropoietin treatment.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Majestic Complex (Posters 61-120)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #100

The Effectiveness of Erythropoietin in Treating Neonatal Hypoxic-Ischemic Encephalopathy: A Systematic Review and Meta-Analysis

Aimee Wang, Columbia University Vagelos College of Physicians and Surgeons, Austin, United States
Paul Lewis, Columbia University Vagelos College of Physicians and Surgeons, New York, United States

Category: Prenatal/Perinatal Factors/Prematurity

Keyword 1: child brain injury
Keyword 2: hypoxia
Keyword 3: perinatal factors

Objective:

Neonatal hypoxic-ischemic encephalopathy (HIE) is a neurological disorder that disrupts homeostatic functions and alters cognitive development. Treatments for this disease are limited. This systematic review and meta-analysis examines the effectiveness of erythropoietin in treating HIE.

Participants and Methods:

A systematic review was conducted following PRISMA guidelines using various iterations of keywords such as ‘erythropoietin,’ ‘treatment,’ and ‘neonatal hypoxic-ischemic encephalopathy’ in PubMed, Google Scholar, and Cochrane databases. A total of 14,400 articles were found from the keywords. These results were narrowed based on title and abstract, which yielded 1179 articles. Articles were excluded based on language (not in English), relevance (focused on diseases other than neonatal HIE), treatment type (in conjunction with other treatments), and study type (not a randomized controlled trial). 16 studies met the criteria and were included in the review. Studies gave the experimental group between 200 IU/kg to 3000 IU/kg of recombinant erythropoietin or erythropoietin intravenously and the control group a placebo saline solution, conventional treatment, or none of the above. Metrics of improvement were determined through the use of biomarkers (blood pressure, cerebral oxygenation, plasma levels) and index or behavioral assessment tests which assessed cognitive, language, motor, social-emotional, and adaptive skills. All study cohort sizes ranged from 40-501 participants; all of which were preterm infants with moderate to severe HIE.

Results:

Combining available participant data across included studies yielded 997 total participants for comparison. Within the meta-analysis, erythropoietin treatment for HIE failed to show significance compared to placebo (OR 1.12, 95% CI [0.88-1.44], p=0.36), The overall efficacy score obtained using the number of metrics across studies that showed improvement was approximately 63% with 10 out of 16 studies reporting improvement. There was heterogeneity within the pool of included studies (Chi2=15.56, I2=74%, p<0.01). For studies claiming improvement, mortality was significantly reduced in the erythropoietin-treated groups (p<0.05). Neurological changes such as the presence of cerebral palsy and disability also reported lower rates for the treatment groups (p<0.05). Most studies utilizing biomarkers reported no significant results through the measurement of blood pressure, cerebral oxygenation, hemoglobin count, plasma levels, or serum levels. Two studies, however, reported improvement through hematocrit and serum levels (p<0.05). All studies using the Neonatal Behavioral Neurological Assessment as its main metric of improvement reported significant improvement between the treatment and control group (p<0.05) and concluded long-term neurological improvement in the erythropoietin-treated group. Studies using the Bayley Scales of Infant Development, however, reported no statistically significant difference between the mean Mental Development Index scores of the two groups.

Conclusions:

The comparisons of the studies yielded varying results with numerous discrepancies. While meta-analysis failed to show significance for treatment, the significant heterogeneity may indicate a role in certain cases or populations. To determine the effectiveness of erythropoietin as a treatment for HIE, an expansion and diversification of research concerning erythropoietin treatment for neonates is warranted to provide a conclusive and holistic evaluation of the efficacy of erythropoietin treatment.