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#091 - 095 - Erythropoiesis Stimulating Agents

Hello Friends 👋

This week we are discussing erythropoiesis stimulating agents. Focusing primarily on erythropoietin, we cover a broad range of topics and issues. Daphna reviewed for us, on Monday, the physiology and mechanism of action of Erythropoietin. With this valuable information on hand, we continued with an interesting discussion on the evidence surrounding the use of erythropoieting for anemia. We then discussed the use of erythropoietin for neuroprotection, covering data for both preterm and term infants. On thursday we had the honor and the pleasure of welcoming to the show the famous Dr. Robin Ohls from the University of Utah who helped us clear up some important questions and clarify certain controversies surrounding the use of EPO in the NICU. As is customary, we finished our week with a series of interesting board review style questions. Please check out all of the resources below including the powerpoint presentation, and link to articles for the episodes this week.


Link to download the PowerPoint and notes from these episodes 👇

The articles covered on this series of episodes can be found here 👇

Effects of early erythropoietin therapy on the transfusion requirements of preterm infants below 1250 grams birth weight: a multicenter, randomized, controlled trial.

Ohls RK, Ehrenkranz RA, Wright LL, Lemons JA, Korones SB, Stoll BJ, Stark AR, Shankaran S, Donovan EF, Close NC, Das A.Pediatrics. 2001 Oct;108(4):934-42. doi: 10.1542/peds.108.4.934.PMID: 11581447 Clinical Trial.


The effect of epoetin beta (recombinant human erythropoietin) on the need for transfusion in very-low-birth-weight infants. European Multicentre Erythropoietin Study Group.

Maier RF, Obladen M, Scigalla P, Linderkamp O, Duc G, Hieronimi G, Halliday HL, Versmold HT, Moriette G, Jorch G, et al.N Engl J Med. 1994 Apr 28;330(17):1173-8. doi: 10.1056/NEJM199404283301701.PMID: 8139627 Free article. Clinical Trial.


Early erythropoiesis-stimulating agents in preterm or low birth weight infants.

Ohlsson A, Aher SM.Cochrane Database Syst Rev. 2020 Feb 11;2(2):CD004863. doi: 10.1002/14651858.CD004863.pub6.PMID: 32048730 Free PMC article.

Late erythropoiesis-stimulating agents to prevent red blood cell transfusion in preterm or low birth weight infants.

Aher SM, Ohlsson A.Cochrane Database Syst Rev. 2020 Jan 28;1(1):CD004868. doi: 10.1002/14651858.CD004868.pub6.PMID: 31990982 Free PMC article.

Erythropoietin improves neurodevelopmental outcome of extremely preterm infants.

Neubauer AP, Voss W, Wachtendorf M, Jungmann T.Ann Neurol. 2010 May;67(5):657-66. doi: 10.1002/ana.21977.PMID: 20437563 Clinical Trial.

Erythropoietin concentrations and neurodevelopmental outcome in preterm infants.

Bierer R, Peceny MC, Hartenberger CH, Ohls RK.Pediatrics. 2006 Sep;118(3):e635-40. doi: 10.1542/peds.2005-3186. Epub 2006 Aug 14.PMID: 16908620 Clinical Trial.

Cognitive outcomes of preterm infants randomized to darbepoetin, erythropoietin, or placebo.

Ohls RK, Kamath-Rayne BD, Christensen RD, Wiedmeier SE, Rosenberg A, Fuller J, Lacy CB, Roohi M, Lambert DK, Burnett JJ, Pruckler B, Peceny H, Cannon DC, Lowe JR.Pediatrics. 2014 Jun;133(6):1023-30. doi: 10.1542/peds.2013-4307. Epub 2014 May 12.PMID: 24819566 Free PMC article. Clinical Trial.

A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants.

Juul SE, Comstock BA, Wadhawan R, Mayock DE, Courtney SE, Robinson T, Ahmad KA, Bendel-Stenzel E, Baserga M, LaGamma EF, Downey LC, Rao R, Fahim N, Lampland A, Frantz ID III, Khan JY, Weiss M, Gilmore MM, Ohls RK, Srinivasan N, Perez JE, McKay V, Vu PT, Lowe J, Kuban K, O'Shea TM, Hartman AL, Heagerty PJ; PENUT Trial Consortium.N Engl J Med. 2020 Jan 16;382(3):233-243. doi: 10.1056/NEJMoa1907423.PMID: 31940698 Free PMC article. Clinical Trial.

Erythropoietin improved neurologic outcomes in newborns with hypoxic-ischemic encephalopathy.

Zhu C, Kang W, Xu F, Cheng X, Zhang Z, Jia L, Ji L, Guo X, Xiong H, Simbruner G, Blomgren K, Wang X.Pediatrics. 2009 Aug;124(2):e218-26. doi: 10.1542/peds.2008-3553. Epub 2009 Jul 27.PMID: 19651565 Clinical Trial.

High-Dose Erythropoietin and Hypothermia for Hypoxic-Ischemic Encephalopathy: A Phase II Trial.

Wu YW, Mathur AM, Chang T, McKinstry RC, Mulkey SB, Mayock DE, Van Meurs KP, Rogers EE, Gonzalez FF, Comstock BA, Juul SE, Msall ME, Bonifacio SL, Glass HC, Massaro AN, Dong L, Tan KW, Heagerty PJ, Ballard RA.Pediatrics. 2016 Jun;137(6):e20160191. doi: 10.1542/peds.2016-0191. Epub 2016 May 2.PMID: 27244862 Clinical Trial.

Systematic review seeking erythropoietin role for neuroprotection in neonates with hypoxic ischemic encephalopathy: presently where do we stand.

Garg B, Sharma D, Bansal A.J Matern Fetal Neonatal Med. 2018 Dec;31(23):3214-3224. doi: 10.1080/14767058.2017.1366982. Epub 2017 Aug 23.PMID: 28797191

Update on Erythropoiesis-Stimulating Agents Administered to Neonates for Neuroprotection.

Maxwell JR, Ohls RK.Neoreviews. 2019 Nov;20(11):e622-e635. doi: 10.1542/neo.20-11-e622.PMID: 31676737 Review.

The Many Facets of Erythropoietin Physiologic and Metabolic Response.

Suresh S, Rajvanshi PK, Noguchi CT.Front Physiol. 2020 Jan 17;10:1534. doi: 10.3389/fphys.2019.01534. eCollection 2019.PMID: 32038269 Free PMC article. Review.

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