The role of early administration of erythropoiesis-stimulating agents in preterm neonatal neuroprotection: a systematic review and meta-analysis
- Forfatter(e)
- Argyropoulou, M., Fotopoulou, E., Kousi, D., Siahanidou, T.
- År
- 2026
- Tidsskrift
- Journal of Perinatology
- Volum
- 24
- Sider
- 24
- Kategori(er)
- Kognisjon (hukommelse, oppmerksomhet og eksekutive funksjoner) For tidlig fødsel
- Tiltakstype(r)
- Abstract
BACKGROUND
Prematurity remains a leading cause of neonatal mortality and morbidity; with neurodevelopmental disorders among its most significant complications. Erythropoiesis-stimulating agents (ESAs) have been explored for their neuroprotective potential.
OBJECTIVE
To evaluate whether early prophylactic administration of ESAs in preterm neonates ( < 37 weeks' gestation) improves neurodevelopmental outcomes up to 36 months of age.
STUDY DESIGN
A systematic search of MEDLINE, Embase, Cochrane Library, and ICTRP identified 1142 studies, of which ten met the inclusion criteria. The meta-analysis included only randomized control trials (RCTs) reporting Bayley Scales of Infant Development scores or cerebral palsy diagnosis.
RESULTS
Among the ten included studies (eight RCTs, two retrospective cohorts), comprising 2861 preterm infants, narrative synthesis was inconclusive. Meta-analysis showed reduced odds of adverse cognitive outcomes (OR: 0.55; 95% CI: 0.35-0.85), and cerebral palsy (OR: 0.66; 95% CI: 0.45-0.97) in ESA-treated group, with no evidence of publication bias. Sensitivity analyses indicated potential fragility of pooled estimates.
CONCLUSION
Epsilonarly ESAs administration may provide cognitive benefits. Standardized methodologies and longer-term studies are needed to confirm neurodevelopmental effects and clinical relevance.