■早产的儿童有长期神经发育后遗症的风险。出生后不久预防性大剂量重组人促红细胞生成素(rhEpo)并未显示出改善认知功能,电机,和行为发展在2年和5年。
■调查早期高剂量rhEpo是否与更好的执行功能和处理速度-晚期-成熟的认知功能-在早产的学龄儿童中。
■这项单中心队列研究是一项前瞻性研究,多中心新生儿临床试验的观察性随访研究;365名早产儿童(平均胎龄,29.3周[范围,26.0-31.9周])在2005年至2012年出生时参加了瑞士EPO神经保护试验,并在2年时被纳入主要结局分析,在2017年至2021年之间,当他们在学龄时,他们有资格被招募参加EpoKids研究。另外招募足月出生的儿童并将其纳入对照组。数据在2022年5月至9月之间进行了分析。
■施用rhEpo(3000IU/kg)或安慰剂(生理盐水,0.9%)作为瑞士EPO神经保护试验的一部分,在生命的前2天内静脉注射3次。
■全面的神经心理学测试电池评估了执行功能和处理速度,父母报告了孩子在日常生活中的执行功能,以检验早期高剂量rhEpo给药与学龄儿童更好的认知结果相关的假设。
■在EpoKids研究中,214名早产儿童(符合条件的队列中365名儿童中的58.6%)的平均年龄为10.4岁(范围,6.9-13.4岁);男孩117人(54.7%)。在15项执行功能和处理速度测试中,没有证据表明接受rhEpo的117名儿童与接受安慰剂的97名儿童不同,在父母评估的执行功能中也是如此(估计值范围为-0.138至0.084,所有95%CI均包括0).不考虑rhEpo或安慰剂分配,非常早产的儿童在15项执行功能和处理速度测试中的11项得分低于足月出生的同龄人(估计值在0.112~0.255之间,95%CI不包括0).
这项研究没有发现预防性早期高剂量rhEpo给药与早产后的长期神经发育结果之间存在正相关的证据。这些结果表明,一个全面的方法,包括药物和非药物预防和干预策略,需要支持这些孩子的神经发育结果。
UNASSIGNED: Children born very preterm are at risk for long-term neurodevelopmental sequelae. Prophylactic high-dose recombinant human erythropoietin (rhEpo) shortly after birth has not been shown to improve cognitive, motor, and behavioral development at 2 and 5 years.
UNASSIGNED: To investigate whether early high-dose rhEpo is associated with better executive functions and processing speed-late-maturing cognitive functions-in school-aged children born very preterm.
UNASSIGNED: This single-center cohort study was a prospective, observational follow-up study of a multicenter neonatal clinical trial; 365 children born very preterm (mean gestational age, 29.3 weeks [range, 26.0-31.9 weeks]) who had been enrolled in the Swiss EPO Neuroprotection Trial at birth between 2005 and 2012, and who were included in the primary outcome analyses at 2 years, were eligible to be recruited for the EpoKids study between 2017 and 2021 when they were at school age. Term-born children were additionally recruited and included in a control group. Data were analyzed between May and September 2022.
UNASSIGNED: Administration of rhEpo (3000 IU/kg) or placebo (saline, 0.9%) intravenously 3 times within the first 2 days of life as part of the Swiss EPO Neuroprotection Trial.
UNASSIGNED: A comprehensive neuropsychological test battery assessed executive functions and processing speed, and parents reported on their child\'s executive functions in everyday life to test the hypothesis that early high-dose rhEpo administration is associated with better cognitive outcomes at school age.
UNASSIGNED: In the EpoKids study, 214 children born very preterm (58.6% of 365 children in eligible cohort) were assessed at a mean age of 10.4 years (range, 6.9-13.4 years); 117 (54.7%) were boys. There was no evidence that the 117 children who had received rhEpo differed from the 97 children who had received placebo in any of the 15 executive function and processing speed tests, nor in parent-rated executive functions (estimates ranged from -0.138 to 0.084, all 95% CIs included 0). Irrespective of rhEpo or placebo allocation, children born very preterm scored lower on 11 of 15 executive function and processing speed tests than term-born peers (estimates ranged from 0.112 to 0.255, 95% CIs did not include 0).
UNASSIGNED: This study found no evidence for a positive association between prophylactic early high-dose rhEpo administration and long-term neurodevelopmental outcomes after very preterm birth. These results suggest that a comprehensive approach, including pharmacological and nonpharmacological prevention and intervention strategies, is needed to support these children\'s neurodevelopmental outcome.