Erythropoietin and the incidence of necrotizing enterocolitis in infants with very low birth weight

Presented at the 30th Annual Meeting of the American Pediatric Surgical Association, Rancho Mirage, California, May 16-19, 1999.
https://doi.org/10.1016/S0022-3468(00)90006-XGet rights and content

Abstract

Background/Purpose: The presence of erythropoietin (Epo) in human milk and the expression of Epo receptors on intestinal villous enterocytes of neonates suggest that Epo has a role in growth and development of the gastrointestinal tract. On this basis, the authors hypothesized that recombinant Epo (rEpo) given for prevention or treatment of the anemia of prematurity would protect against necrotizing enterocolitis (NEC). Methods: A retrospective cohort study was conducted from a university neonatal intensive care unit of 483 very low birth weight (500 to 1,250 g) neonates born from July 1, 1993 to January 1, 1998. Results: A total of 260 neonates received rEpo, and 223 did not (control group). The rEpo and control groups were similar in gender distribution (52% v 48% boys), gestational age (26.8 ± 2.1 v 27.6 ± 2.9 weeks; mean ± SD), birth weight (895 ± 198 v 911 ± 208 g), 1 and 5 minute Apgar scores (4.2 and 6.1 v 4.7 and 6.7), and incidence of severe intraventricular hemorrhage (8.9% v 10.3%). The rEpo group had a lower incidence of NEC (12 of 260, 4.6% v 24 of 223, 10.8%; P =.028, 95% confidence interval for difference: −0.108 to −0.015). Conclusion: In very low birth weight infants, the incidence of NEC is lower in those who received rEpo. J Pediatr Surg 35:178-182. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Materials and methods

The study design was a retrospective cohort study of very low birth weight babies in a university neonatal intensive care unit (NICU). Neonates admitted to the NICU of Shands Hospital at the University of Florida were eligible for this study if their birth weight was ≥500 and ≤1,250 g, and they were born between July 1, 1993 and January 1, 1998. Infants were excluded if they died on the first day of life.

Infants who received rEpo at any time before the onset of NEC were assigned to the rEpo

Results

Five hundred four very low birth weight infants (500 to 1,250 g) were born between July 1, 1993 and January 1, 1998, and cared for in the NICU of Shands Teaching Hospital at the University of Florida. Of these, 483 survived the first day of life, and were included in our analysis. Of the 483 babies, 260 (54%) received rEpo, and 223 (46%) were controls. Thirteen infants in the control group received rEpo therapy after the diagnosis of NEC. The control group and the rEpo groups were similar in

Discussion

Necrotizing enterocolitis is a devastating disease that even when recognized promptly and treated optimally has a significant mortality and morbidity rate.1 It is thought that pathogenic bacteria, feedings, and mucosal compromise combine in a susceptible host to produce the bowel injury responsible for the typical clinical findings.12 Once present, the most important determinant of outcome is the extent and severity of bowel injury, so the ideal way to reduce the mortality and morbidity would

References (25)

  • WM Gersony et al.

    Effects of indomethacin in premature infants with patent ductus arteriosus: Results of a national collaborative study

    J Pediatr

    (1983)
  • RM Kliegman et al.

    Neonatal necrotizing enterocolitis: Pathogenesis, classification, and spectrum of illness

    Curr Probl Pediatr

    (1987)
  • Cited by (113)

    • Toll-Like Receptor–Mediated Intestinal Inflammatory Imbalance in the Pathogenesis of Necrotizing Enterocolitis

      2018, Cellular and Molecular Gastroenterology and Hepatology
      Citation Excerpt :

      This observation has led to significant interest in seeking to understand the molecular components of breast milk that confer protection against NEC. Earlier studies have focused on the presence of immunoprotective IgA,102 lactoferrin,103 and erythropoietin.104 More recent studies have focused on probiotic bacteria within breast milk,105 and the nondigestible human milk oligosaccharides that are present in breast milk and reduce NEC through inhibition of bacterial enterocyte binding and enhanced mucosal perfusion.86,106–108

    • Key Concepts in Immunologic Functions of Human Milk

      2017, Fetal and Neonatal Physiology, 2-Volume Set
    View all citing articles on Scopus

    Address reprint requests to Daniel J. Ledbetter, MD, Department of Surgery, Division of Pediatric Surgery, Health Science Center, PO Box 100286, University of Florida College of Medicine, Gainesville, FL 32610-0286.

    View full text