Endogenous erythropoietin concentrations and association with retinopathy of prematurity and brain injury in preterm infants

Nancy M. Fahim, Michael K. Georgieff, Lei Zhang, Scott Naisbitt, Raghavendra B. Rao, Terrie E. Inder

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3 Scopus citations


BACKGROUND: Endogenous erythropoietin (EPO) concentrations vary widely in preterm infants and may be associated with perinatal risk factors and neurological outcomes. Erythropoietin is elevated in fetal hypoxia but is also a potential neuroprotectant.

METHODS: In a prospective study of 27 infants ≤ 30 weeks gestation, serum erythropoietin concentrations were measured during the first month of life, on day 1 and weeks 1, 2, and 4, and related to perinatal risk factors and outcomes including retinopathy of prematurity and cerebral injury evaluated near term-equivalent post menstrual age using magnetic resonance imaging with quantitative scoring.

RESULTS: Lower birth weight was associated with higher EPO concentrations throughout the first 2 weeks of life (r = -0.6, p < 0.01). Higher day 1 and week 1 EPO concentrations were associated with lower Apgar score at 1 minute (r = - 0.5) and 5 minutes (r = -0.7), respectively (p < 0.01). Higher day 1 EPO concentrations and 2-week area under the curve were associated with increased risk (p = 0.01) and severity (r = 0.5, p < 0.02) of retinopathy of prematurity. Higher EPO concentrations at 2 weeks were associated with increased total brain injury score (r = 0.5, p < 0.05).

CONCLUSION: Elevated endogenous erythropoietin concentrations in the first two weeks of life are associated with lower birth weight and increased risk of adverse outcomes.

Original languageEnglish (US)
Article numbere0252655
JournalPloS one
Issue number6 June
StatePublished - Jun 2021

Bibliographical note

Funding Information:
TEI (author), NICHD grant HD057098-01, National Institute of Child Health and Human Development, https://www.nichd.nih.gov/ - LZ (author) and SL (acknowledged) as members of the CTSI department (Clinical and Transitional Science Institute), NCATS award UL1-TR002494, National Center for Advancing Translational Sciences, https://ncats.nih.gov/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
Copyright © 2021 Fahim et al.


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