Treatment of premature infants with red blood cell–stimulating agents such as erythropoietin or darbepoetin in the early weeks of life may have long-term benefits on cognitive outcomes and brain development, according to a study released today in Pediatrics.
Erythropoietin and darbepoetin, which help stimulate the bone marrow to produce more red blood cells, are used in both children and adults to treat certain types of chronic anemia (low red blood cell counts). However, early studies in both animals and humans have suggested that these agents also may act on nerve cells in the brain and have positive effects on brain development and cognition. Such effects could be particularly helpful for premature infants, in whom incomplete brain development often results in future complications, such as cerebral palsy or developmental delay.
Researchers from the University of New Mexico in Albuquerque randomly assigned more than 100 premature, very low-birth-weight infants (500 to 1250 grams at birth) to receive injections of erythropoietin, darbepoetin, or placebo from birth to what would have been 35 weeks gestation. When the infants were evaluated for cognitive outcomes at age 18 to 22 months (by individuals who didn’t know whether the infants received one of the drugs or placebo), scores on cognitive testing were significantly higher among infants in both the erythropoietin and darbepoetin groups compared with the placebo group.
The authors found no difference in weight, head circumference, hearing impairment, or visual impairment among the 3 groups. However, 5 of the 24 children in the placebo group had a diagnosis of cerebral palsy vs none of the 56 children in the erythropoietin or darbepoetin groups.
The study did not include enough patients to determine if there was a difference between erythropoietin and darbepoetin. Previous studies looking at erythropoietin and cognitive outcomes have had mixed results, but this is the first randomized trial involving darbepoetin, which the authors suggest may be more advantageous because darbepoetin treatment only requires a once-weekly injection compared with erythropoietin, which requires 3 injections per week.