Efficacy and Safety of High-Dose Erythropoietin Combined with Hypothermia Therapy in Neonatal Hypoxic-Ischemic Encephalopathy: A Systematic Review and Meta-Analysis.

Abstract

This study was conducted to systematically evaluate the effectiveness and safety of high-dose erythropoietin (EPO) combined with hypothermia in treating neonatal hypoxic-ischemic encephalopathy (HIE) using meta-analysis (MA) and providing insights for the clinical application of this treatment approach. Clinical randomized controlled trials on EPO combined with hypothermia for neonatal HIE were identified through computer searches of databases, including Chinese National Knowledge Infrastructure (CNKI), Web of Sciences, Embase, and PubMed up to May 20, 2024. Screening, data extraction, and quality assessment were independently performed by two researchers, with MA conducted using RevMan5.3. 12 studies involving 1562 infants were included. MA results indicated greatly lower odds in the EPO group (EG) versus the Control group (CG) for mortality, acute brain injury, intellectual developmental index < 70, and motor developmental index < 70 [odds ratio (OR) = 0.65, 95%CI = 0.47-0.91, p = 0.01; OR = 0.51, 95%CI = 0.25-1.01, p = 0.05; OR = 0.47, 95%CI = 0.22-1.00, p = 0.05; OR = 0.44, 95%CI = 0.20-1.00, p = 0.05]. EG and CG demonstrated neglectable differences in terms of hospital stay duration, renal failure/injury rate, incidence of neurological developmental abnormalities, and antiepileptic drug usage (p > 0.05). High-dose EPO combined with hypothermia in the treatment of neonatal HIE effectively reduced mortality rates and improved intellectual and motor developmental outcomes.