Feasibility and Safety of Erythropoietin for Neuroprotection after Perinatal Arterial Ischemic Stroke

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• 作者：Manon J. Benders ; MD ; PhD¹ ; ^{m.benders@umcutrecht.nl" class="auth_mail} ; Niek E. van der Aa ; MD¹ ; Maurice Roks ; MPA¹ ; Henrica L. van Straaten ; MD ; PhD² ; Ivana Isgum ; PhD³ ; Max A. Viergever ; PhD³ ; Floris Groenendaal ; MD ; PhD¹ ; ³ ; Linda S. de Vries ; MD ; PhD¹ ; Frank van Bel ; MD ; PhD¹
• 关键词：ADC ; Apparent diffusion coefficient ; DWI ; Diffusion-weighted imaging ; EPO ; Erythropoietin ; MCA ; Middle cerebral artery ; MRI ; Magnetic resonance imaging ; PCA ; Posterior cerebral artery ; rhEPO ; Recombinant human erythropoietin ; TE ; Echo time ; TR ; Repetition time
• 刊名：The Journal of Pediatrics
• 出版年：March, 2014
• 年：2014
• 卷：164
• 期：3
• 页码：481-486.e2
• 全文大小：668 K

文摘

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Objective

To perform a feasibility and safety study with recombinant human erythropoietin (rhEPO) in neonates with perinatal arterial ischemic stroke.

Study design

Neonates with a magnetic resonance imaging-confirmed perinatal arterial ischemic stroke (n = 21) were treated with 1000 IU/kg rhEPO immediately after diagnosis and at 24 and 48 hours after the first dose. Repeat magnetic resonance imaging was performed when the patients were 3 months of age. Coagulation and hematologic variables (red blood cells, white blood cells, platelet counts) were performed in the first week after initiation of treatment. We also compared 10 patients who were treated with rhEPO with 10 historic infants with perinatal arterial ischemic stroke matched for the involved arterial branch to investigate whether rhEPO reduces the residual size of the infarction and subsequent brain growth between first and second scan.

Results

Seizures were a first symptom in 20 of 21 neonates. Heart rate, blood pressure, and coagulation function were in the normal range, as were red blood cells, white blood cells, and platelet counts. In a subgroup of 10 rhEPO-treated neonates, no differences were detected in residual infarction volumes or neurodevelopmental outcome compared with their historical nontreated counterparts.

Conclusions

rhEPO in neonates with perinatal arterial ischemic stroke had no adverse effects on red blood cells, white blood cells, platelets counts, or coagulation. rhEPO, 3000 IU/kg in total, given during a 3-day period, appears to be a safe therapy. The beneficial effects remains to be demonstrated in a larger, randomized, double-blind, placebo-controlled trial.