Neuroprotective Strategies for Hypoxic Ischemic Encephalopathy

Leslie Parker, PhD, NNP-BC; Carole Kenner, DNS, RNC-NIC, FAAN


NAINR. 2012;12(1):8-11. 

In This Article

Erythropoietin (Epogen)

Research has recently indicated that Epogen (Thousand Oaks, CA), traditionally used to enhance erythropoiesis, may also provide neuroprotection to infants with HIE. Epogen receptors are present in the developing human embryo, and higher levels of Epogen in cerebral spinal fluid have been correlated with improved neurodevelopmental outcomes.[15] Epogen may benefit infants with HIE through protection from neuronal apoptosis, neural regeneration, decreased inflammation, and decreased susceptibility to glutamate toxicity.[16]

Preterm infants treated with Epogen for promotion of erythropoiesis have demonstrated improved neurodevelopmental outcomes.[17] Term infants with HIE treated with Epogen show decreased seizure activity, improved EEG results, and enhanced neurologic outcome.[18,19] Although additional clinical trials are needed, Epogen appears to be effective in the treatment of infants with HIE if administered within 48 hours after delivery.

One concern regarding administration of Epogen for neuroprotection is that higher than normal doses may be required to ensure penetration of the blood brain barrier. Doses of up to 3000 U/kg have been shown to be safe in preterm infants, suggesting that higher doses may be acceptable for use in this population.[20] Concern also exists regarding potential adverse reactions associated with Epogen. Although significant side effects including hypertension, clotting abnormalities, seizures, and polycythemia have not been seen in neonates, they have been reported in the adult population.[21] In addition, 1 study reported an increased incidence of retinopathy of prematurity in premature infants treated with Epogen, which is of particular concern if high doses are to be administered.[22] Additional research is required to more adequately assess whether Epogen is an effective therapy for HIE and to answer questions regarding optimal dosage, timing, and length of treatment.


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