Single dose recombinant erythropoietin versus moderate hypothermia for neonatal hypoxic ischemic encephalopathy in low resource settings
Single dose recombinant erythropoietin versus moderate hypothermia for neonatal hypoxic ischemic encephalopathy in low resource settings
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DOI：
10.3109/14767058.2013.855894
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发表时间：
2014-09-01
影响因子：
1.8
通讯作者：
El Maraghy, Mohamed O.
中科院分区：
文献类型：
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作者：
El Shimi, M. Sami;Awad, Hisham A.;El Maraghy, Mohamed O.
目的：探讨单剂量系统性重组人促红细胞生成素（rEPO）治疗围产儿缺氧缺血性脑病（HIE）的安全性和有效性，以及对血清脑源性神经营养因子（BDNF）和神经元特异性烯醇化酶（NSE）的影响。方法：45例足月新生儿；研究围产期HIE患儿30例，对照组15例。HIE新生儿随机分为三个干预组（出生后6小时）：10例在第1天接受单次皮下1500 U/kg rEPO治疗，10例接受低温治疗72小时，10例接受支持治疗。BDNF和NSE分别于产后6小时和第5天测定。对3个月大的幸存者进行每日汤普森评分，MRI脑和神经肌肉功能量表。结果：低温组生存率最高，尤以Sarnat分期最高，其次为rEpo组和支持组。与对照组相比，各组第5天BDNF显著升高。与rEPO组相比，低温组的MRI评分和神经肌肉功能评分无显著降低。结论：治疗性低温治疗对HIE患者的神经保护效果优于单剂量rEpo，特别是对ii期Sarnat评分患者。rEPO多剂量联合适度低温治疗的疗效有待研究。
Objective: To determine the safety and efficacy of single dose systemic recombinant human erythropoietin (rEPO) in neonates with perinatal hypoxic Ischemic Encephalopathy (HIE), and its effect on serum brain-derived neurotrophic factor (BDNF) and neuron-specific enolase (NSE).Methods: Forty-five full-term neonates; 30 with perinatal HIE and 15 controls were studied. HIE neonates were randomized into three intervention groups (first 6 h of life): 10 received single subcutaneous 1500 U/kg rEPO at day-1, 10 subjected to hypothermia for 72 h and 10 received supportive care. BDNF and NSE measured during first 6 h and day 5 postnatal. Daily Thompson's score, MRI brain and neuromuscular function scale for survivors at 3 months of age were done.Results: Hypothermia group had best survival especially with stage-II Sarnat scale, followed by rEpo and supportive group. BDNF day-5 was significantly higher in each group compared to controls. MRI score and neuromuscular function score were non-significantly lower in the hypothermia group compared to rEPO.Conclusions: Therapeutic hypothermia was superior to single dose rEpo for neuro-protection in HIE especially in patients with stage-II Sarnat scale. Therapeutic effect of combined rEPO multiple dosing and modest hypothermia therapy should be studied.