27 August 2014

Synthetic hormone may protect preemies' brains

Synthetic erythropoietin (EPO), a hormone used to stimulate red blood cell production, might prevent brain damage when used shortly after preterm birth.

A hormone used to reduce the need for blood transfusions might also protect the brains of premature babies, a new study suggests.

Synthetic erythropoietin (EPO), which stimulates red blood cell production, appears to prevent brain damage when used shortly after preterm birth, said lead researcher Dr. Petra Huppi, a professor of paediatrics and newborn medicine at the University of Geneva, in Switzerland.

"The real test of whether EPO protects the brains of these children will be when they are evaluated when they are older," she said.

Health risks for preemies

Infants born before the 32nd week of pregnancy face dire health risks, including brain damage and incomplete development of the brain, especially the part of the brain called white matter.

Many are left with long-term developmental disabilities, including motor and thinking problems, and attention and learning difficulties, the researchers noted.

Huppi noted that EPO, commonly used to treat anaemia, is safe and has no side effects. It's been used to treat premature infants for decades, she said. Its use as a performance enhancer in sports has been banned.

In the first step of the study, published in the Journal of the American Medical Association, researchers reviewed MRI brain scans of 165 infants. Close to half had received three doses of EPO within two days of delivery.

MRI scans done when the infants were the equivalent age of a full-term birth found that the brains of babies who received EPO showed less damage than the brains of infants who hadn't been given the hormone.

EPO a benefit to preterm baby brains

According to Huppi, this is the first study that has shown a benefit of EPO on the brains of preterm babies.

However, Dr. David Mendez, a neonatologist at Miami Children's Hospital, remains sceptical.

"The role EPO has in protecting brain tissue is still theoretical and not proven," he said. "This study raises more questions than it answers."

Read: 'Extreme preemies' mostly do catch up

Over the years, many different drugs have been tried to preserve the brain tissue of preemies, Mendez said. "The most recent incarnation of this is the use of EPO," he said. But still more work is needed, Mendez said.

In this study, too few children were given EPO to say the findings weren't purely by chance, he said. The association reported in the study does not prove a cause-and-effect relationship.

Mendez also said that although EPO has been used for years to reduce the need for blood transfusions in preemies, its use is falling out of favour.

Dangers of EPO

"There has been some concern that EPO reduces white blood cell counts and there is some concern that EPO may predispose the baby to have an eye condition called 'retinopathy of prematurity' that can lead to blindness," he said. "A lot of neonatologists don't even use EPO anymore."

Read: Preemies at risk of retinal detachment

As for the brain scans, Mendez said it's easy to tell a completely normal brain from a completely damaged one, but it's not as easy to evaluate the area between the two, which is where most preemies fall, he said.

Huppi said the next stage of the study is to test the children when they are 2 and 5 years old. This assessment will confirm whether or not EPO really protects the brains of premature babies, she said.

"If this does turn out to be the case, this will be an important step in preventing brain damage and its consequences in premature babies," Huppi said.

Read more:
Gum disease linked to preemies
Preemies who cry a lot may have problems later on

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