Effect of Erythropoietin on Neurodevelopmental Outcomes in Very Preterm Infants With Intraventricular Hemorrhage

Study Overview
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Brief Summary
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Erythropoietin (EPO) has been shown to be neurotrophic and neuroprotective in several animal models and some clinical studies. Our hypothesis is that EPO could improve long-term neurological outcomes in very preterm infants with intraventricular hemorrhage (IVH). The aim of this study is to evaluate the long-term neuroprotective effect of repeated low-dose EPO (500 U/kg) in very preterm infants with IVH.

Detailed Description
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IVH is one of the most common complications in preterm infants. Nearly 60% of preterm infants with grade III-IV IVH develop severe neurodevelopmental outcomes. There are currently no effective treatments to prevent preterm infants with IVH from developing ventricular dilation or serious neurological disabilities. Recent studies have shown that EPO could improve neurodevelopmental outcomes in preterm infants with grade III-IV IVH. However, the dose and course of EPO in preterm infants is still uncertain. The purpose of the study was whether repeated low-dose EPO (500 U/kg, every other day, for 2 weeks) given to very preterm right after the diagnosis of IVH could improve long-term neurological outcomes. Very preterm infants with gestational age of ≤ 32 weeks who are diagnosed with IVH within 72 hours after birth in NICU are eligible for enrolment. After informed consent is obtained, infants will be randomly assigned to EPO group or vehicle group. The primary outcome is whether EPO improves mortality and neurological disabilities in very preterm infants with IVH at 18 months of corrected age, and the secondary outcome was whether EPO decrease the incidence of cerebral palsy, MDI<70, blindness, and deafness.

Official Title
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Effect of Erythropoietin on Neurodevelopmental Outcomes in Very Preterm Infants With Intraventricular Hemorrhage

Conditions
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Premature Infants

Intervention / Treatment
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* Drug: Erythropoietin
* Drug: Normal saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Preterm infants admitted to NICU ≤ 32 weeks gestation at birth Birth weight less than 1500 g Less than 72 hours of life at time of enrolment Diagnosed as IVH by head ultrasound Written informed consent of parent or guardian Exclusion Criteria: Genetic metabolic diseases Congenital abnormalities Polycythaemia (Hct > 65%) within first 24 hours of life Thrombocytopenia (platelets < 50K cells/microL) within first 24 hours of life Unstable vital signs (such as respiration and circulation failure)

Ages Eligible for Study
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Maximum Age: 72 Hours

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Erythropoietin<br>EPO is administered 500IU/kg, intravenously after diagnosis of IVH within 72h after birth, and every other day for 2 weeks. Recombinant human erythropoietin was configured by the hospital pharmacy intravenous Centre Configuration, melted configured with saline to 1ml/kg solution. | Drug: Erythropoietin<br>* EPO is administered 500IU/kg, intravenously after diagnosis of IVH within 72h after birth, and every other day for 2 weeks.<br>* Other names: Epoietin Beta;|
| Placebo Comparator: Normal saline<br>Normal saline is administered the same volume with EPO, intravenously after diagnosis of IVH within 72h after birth, and every other day for 2 weeks. | Drug: Normal saline<br>* Normal saline is administered the same volume with EPO, intravenously after diagnosis of IVH within 72h after birth, and every other day for 2 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | To compare the death rate in EPO treatment and control groups at 18 months of corrected age. | At corrected age of 18 months | 
| Incidence of neurological disability | To evaluate neurodevelopmental function via Bayley Infant Development scale (2nd Edition), visual acuity and auditory brainstem response measurements at 18 months of corrected age. | At corrected age of 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of cerebral palsy | To compare the incidence of cerebral palsy in EPO treatment and control groups at 18 months of corrected age. | At corrected age of 18 months | 
| Incidence of MDI<70 | To compare the incidence of MDI<70 via Bayley Infant Development scale (2nd Edition) in EPO treatment and control groups at 18 months of corrected age. | At corrected age of 18 months | 
| Incidence of blindness | To compare the incidence of blindness via visual acuity and sight radius examinations in EPO treatment and control groups at 18 months of corrected age. | At corrected age of 18 months | 
| Incidence of deafness | To compare the incidence of deafness via auditory brainstem response measurements in EPO treatment and control groups at 18 months of corrected age. | At corrected age of 18 months | 
| The effect of EPO treatment on blood mRNA expression | To investigate different mRNA expression between EPO and control group, peripheral venous blood of preterm infants after EPO treatment will be collected in both EPO group and control group, and the transcriptome of the premature infant blood will be assayed by RNA sequencing. | At 3 weeks after birth |