High-dose erythropoietin (EPO; a hormone) administered within 42 hours of birth to preterm infants was associated with a reduced risk of brain injury, as indicated by magnetic resonance imaging, according to a study in the August 27 issue of JAMA.

Survival of premature infants has improved over the past decades, but at the expense of an increase in the number of infants affected by long-term developmental disabilities. Premature infants are at risk of developing encephalopathy of prematurity, which includes structural changes of brain white and gray matter and is associated with long-term neurodevelopmental delay. Erythropoietin has shown beneficial effects on neurodevelopmental outcomes in observational and retrospective studies, according to background information in the article.

Russia Ha-Vinh Leuchter, M.D., of the University Hospital of Geneva, Switzerland, and colleagues conducted a study in which 495 infants (born from 26 weeks to 31 weeks and 6 days of gestation) were randomly assigned to receive recombinant human erythropoietin (n=256) or placebo (n=239) intravenously before 3 hours, at 12 to18 hours, and at 36 to 42 hours after birth. In a nonrandomized subset of 165 of the 495 infants (n=77 erythropoietin; n=88 placebo), brain abnormalities were evaluated on magnetic resonance imaging (MRI) acquired at term-equivalent age.

The researchers found that at term-equivalent age, compared with untreated controls, fewer infants treated with recombinant human erythropoietin had abnormal scores for white matter injury (22 percent vs 36 percent); white matter signal intensity (3 percent vs 11 percent); periventricular white matter loss (18 percent vs 33 percent); and gray matter injury (7 percent vs 19 percent).

"These findings require assessment in a randomized trial designed primarily to assess this outcome, as well as investigation of the association with neurodevelopmental outcomes," the authors conclude.