Preterm babies are at an increased risk of developing brain damage. A new study has found, however, that administering the hormone EPO could help to reduce this risk.

The World Health Organization (WHO) reports that an estimated 15 million babies are born preterm (before 37 weeks of gestation). Around 1 million children die each year as a result of preterm birth complications, with many more facing long-term developmental disabilities.

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Preterm babies are currently given EPO to reduce the risk of them needing a blood transfusion. EPO increases the production of red blood cells and hemoglobin.

Preterm birth can cause brain damage and incomplete maturation of the brain, potentially leading to attention and learning difficulties and visual and hearing problems. It can particularly affect the white matter – the part of the brain that is responsible for spreading information within the central nervous system.

High-dose erythropoietin (EPO) is a hormone that is commonly used to treat anemia in kidney disease patients. It is also given to preterm infants as it can reduce the need for blood transfusions. EPO is infamously known for its usage as a performance-enhancing drug by athletes – particularly in competitive cyclists during the 1990s.

Recent studies have found that EPO has a neuroprotective quality – that it can help protect the central nervous system from injury or degeneration. As a result, the effect of high-dose EPO for neuroprotection in preterm infants was investigated as the first part of a major Swiss study on cognitive development.

A team of specialists in infant brain imaging from the Faculty of Medicine at the University of Geneva (UNIGE) and the University Hospital of Geneva (HUG) in Switzerland conducted the initial research. The study was sponsored by the Swiss National Science Foundation.

The researchers randomly assigned 495 preterm infants (born from 26 weeks to 31 weeks and 6 days of gestation) to receive intravenously three doses of either EPO or a placebo shortly after birth – before 3 hours after birth, at 12-18 hours after birth and 36-42 hours after birth.

Following this, the brains of a non-randomized selection of 165 of the infants were evaluated with magnetic resonance imaging (MRI). This group was comprised of 77 who had received EPO and 88 who had received the placebo.

“We found that the brains of children who had received the treatment had much less damage than those in the control group who had been given a placebo,” states Dr. Russia Ha-Vinh Leuchter, co-author of the study. “This is the first time that the beneficial effect of the EPO hormone on the brains of premature babies has been shown.”

At term equivalent age, preterm infants treated with EPO were found to have fewer abnormal scores for the following forms of brain damage in comparison with the infants who had received placebo:

  • Gray matter injury: 7% compared with 19%
  • Periventricular white matter loss: 18% compared with 33%
  • White matter injury: 22% compared with 36%
  • White matter signal intensity: 3% compared with 11%.

These figures illustrate a significant difference and seemingly verify the impact of EPO on premature babies’ brains.

The authors suggest “these findings require assessment in a randomized trial designed primarily to assess this outcome, as well as investigation of the association with neurodevelopmental outcomes.”

This initial study is only the first part of a larger research project. The second and main part will involve the investigation of the children’s neurocognitive development between the ages of 2 and 5. Lead author Prof. Petra Hüppi says that this will go some way to confirming their findings:

State-of-the-art developmental testing as performed in our Swiss Developmental Pediatric units should confirm the effect that EPO treatment has on the neurodevelopment disabilities that very premature babies often show during their infancy.”

“If this does turn out to be the case, we will have taken an important step in preventing brain damage and its long-term consequences in premature babies,” she concludes.

The initial findings of this research are interesting enough, but the main findings are still to come. Survival of preterm infants has improved over the past decades but has led to increased numbers of infants affected by developmental disorders. The findings of the Swiss researchers could prove to be of key importance in the future.

Recently, Medical News Today reported on a newly identified genetic risk factor for premature birth.