Single dose recombinant erythropoietin versus moderate hypothermia for neonatal hypoxic ischemic encephalopathy in low resource settings

J Matern Fetal Neonatal Med. 2014 Sep;27(13):1295-300. doi: 10.3109/14767058.2013.855894. Epub 2013 Nov 13.


Objective: To determine the safety and efficacy of single dose systemic recombinant human erythropoietin (rEPO) in neonates with perinatal hypoxic Ischemic Encephalopathy (HIE), and its effect on serum brain-derived neurotrophic factor (BDNF) and neuron-specific enolase (NSE).

Methods: Forty-five full-term neonates; 30 with perinatal HIE and 15 controls were studied. HIE neonates were randomized into three intervention groups (first 6 h of life): 10 received single subcutaneous 1500 U/kg rEPO at day-1, 10 subjected to hypothermia for 72 h and 10 received supportive care. BDNF and NSE measured during first 6 h and day 5 postnatal. Daily Thompson's score, MRI brain and neuromuscular function scale for survivors at 3 months of age were done.

Results: Hypothermia group had best survival especially with stage-II Sarnat scale, followed by rEpo and supportive group. BDNF day-5 was significantly higher in each group compared to controls. MRI score and neuromuscular function score were non-significantly lower in the hypothermia group compared to rEPO.

Conclusions: Therapeutic hypothermia was superior to single dose rEpo for neuro-protection in HIE especially in patients with stage-II Sarnat scale. Therapeutic effect of combined rEPO multiple dosing and modest hypothermia therapy should be studied.

Keywords: Brain-derived neurotrophic factor; erythropoietin; hypothermia; neurone-specific enolase; perinatal hypoxia.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Case-Control Studies
  • Developing Countries*
  • Erythropoietin / administration & dosage*
  • Female
  • Humans
  • Hypothermia, Induced*
  • Hypoxia-Ischemia, Brain / drug therapy*
  • Infant, Newborn
  • Male
  • Prospective Studies
  • Severity of Illness Index
  • Treatment Outcome


  • Erythropoietin