Elevated Endogenous Erythropoietin Concentrations Are Associated with Increased Risk of Brain Damage in Extremely Preterm Neonates

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Steven J.,Allred,Elizabeth,Logan,J. Wells,Fichorova,Raina Korzeniewski (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: BackgroundWe sought to determine, in very preterm infants, whether elevated perinatal erythropoietin(EPO) concentrations are associated with increased risks of indicators of brain damage,and whether this risk differs by the co-occurrence or absence of intermittent or sustainedsystemic inflammation (ISSI).MethodsProtein concentrations were measured in blood collected from 786 infants born before the28th week of gestation. EPO was measured on postnatal day 14, and 25 inflammationrelated proteins were measured weekly during the first 2 postnatal weeks. We defined ISSIas a concentration in the top quartile of each of 25 inflammation-related proteins on two separate days a week apart. Hypererythropoietinemia (hyperEPO) was defined as the highestquartile for gestational age on postnatal day 14. Using logistic regression and multinomiallogistic regression models, we compared risks of brain damage among neonates with hyperEPO only, ISSI only, and hyperEPO+ISSI, to those who had neither hyperEPO norISSI, adjusting for gestational age.ResultsNewborns with hyperEPO, regardless of ISSI, were more than twice as likely as those without to have very low (< 55) Mental (OR 2.3; 95% CI 1.5-3.5) and/or Psychomotor (OR 2.4;95% CI 1.6-3.7) Development Indices (MDI, PDI), and microcephaly at age two years (OR2.4; 95%CI 1.5-3.8). Newborns with both hyperEPO and ISSI had significantly increasedrisks of ventriculomegaly, hemiparetic cerebral palsy, microcephaly, and MDI and PDI < 55(ORs ranged from 2.2-6.3), but not hypoechoic lesions or other forms of cerebral palsy, relative to newborns with neither hyperEPO nor ISSI.ConclusionhyperEPO, regardless of ISSI, is associated with elevated risks of very low MDI and PDI,and microcephaly, but not with any form of cerebral palsy. Children with both hyperEPOand ISSI are at higher risk than others of very low MDI and PDI, ventriculomegaly, hemiparetic cerebral palsy, and microcephaly.

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Language: English

Date: 2015

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