• Hendrik S Fischer, Nora J Reibel, Christoph Bührer, and Christof Dame.
• Department of Neonatology, Charité University Medical Center, Berlin, Germany.
• Pediatrics. 2017 May 1; 139 (5).

ContextRecombinant human erythropoietin (rhEPO) is a promising pharmacological agent for neuroprotection in neonates.ObjectiveTo investigate whether prophylactic rhEPO administration in very preterm infants improves neurodevelopmental outcomes in a meta-analysis of randomized controlled trials (RCTs).Data SourcesMedline, Embase, and the Cochrane Central Register of Controlled Trials were searched in December 2016 and complemented by other sources.Study SelectionRCTs investigating the use of rhEPO in preterm infants versus a control group were selected if they were published in a peer-reviewed journal and reported neurodevelopmental outcomes at 18 to 24 months' corrected age.Data ExtractionData extraction and analysis followed the standard methods of the Cochrane Neonatal Review Group. The primary outcome was the number of infants with a Mental Developmental Index (MDI) <70 on the Bayley Scales of Infant Development. Secondary outcomes included a Psychomotor Development Index <70, cerebral palsy, visual impairment, and hearing impairment.ResultsFour RCTs, comprising 1133 infants, were included in the meta-analysis. Prophylactic rhEPO administration reduced the incidence of children with an MDI <70, with an odds ratio (95% confidence interval) of 0.51 (0.31-0.81), P < .005. The number needed to treat was 14. There was no statistically significant effect on any secondary outcome.ConclusionsProphylactic rhEPO improved the cognitive development of very preterm infants, as assessed by the MDI at a corrected age of 18 to 24 months, without affecting other neurodevelopmental outcomes. Current and future RCTs should investigate optimal dosing and timing of prophylactic rhEPO and plan for long-term neurodevelopmental follow-up.Copyright © 2017 by the American Academy of Pediatrics.

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