428 - Association between erythropoietin and retinopathy of prematurity: a retrospective cohort study in Japan, 2008-2018

Poster Number: 428
Publication Number: 428.137

Kana Fukui, Division of Neonatology, National Center for Child Health and Development, Okura, Setagaya area,, Tokyo, Japan; Yushi Ito, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Masayo Kokubo, Nagano Children's Hospital, Azumino, Nagano, Japan; Hidehiko Nakanishi, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Shinya Hirano, Osaka Women's and Childrens Hospital, Izumi, Osaka, Japan; Satoshi Kusuda, Kyorin University, Taito, Tokyo, Japan; Shuichi Ito, Yokohama City University, Graduate School of Medicine, Yokohama, Kanagawa, Japan; Tetsuya Isayama, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan

Background: Concerns exist regarding an association between erythropoietin use and retinopathy of prematurity (ROP) in very preterm infants due to angiogenic properties of erythropoietin.

Objective: To assess the association between erythropoietin use and ROP development in preterm infants.

Design/Methods: This retrospective cohort study included infants born at 22-27 weeks gestations in 2008-2018 who were admitted to tertiary neonatal intensive care units in the Neonatal Research Network of Japan. This study excluded infants with major congenital anomalies, those with missing data on erythropoietin use, and those who died within 28 days of birth (because they had less time or opportunity to receive erythropoietin). We compared the primary outcome (ROP requiring treatment) and secondary outcomes (death before discharge, death or ROP, focal intestinal perforation [FIP], necrotizing enterocolitis [NEC], chronic lung disease at 36 weeks postmenstrual age [CLD], death or CLD) between infants who used erythropoietin (erythropoietin group) and those not (control group). To account for clustering within hospitals as random effects, we used a mixed-effects logistic regression model to estimate odds ratios adjusted for potential confounders (antenatal steroids, clinical chorioamnionitis, out-born infant, gestational age, Apgar score at 5 min categorized into 0-3, 4-6, 7-10, and tracheal intubation at birth) as fixed effects. The data regarding the starting date and duration of erythropoietin use were not available.

Results: After excluding 2924 cases from 18955 infants born at 22-27 weeks gestations, this study included 16031 infants, among which 14373 infants (89.7%) used erythropoietin. Infants in the erythropoietin group had higher incidences of clinical chorioamnionitis, premature rupture of the membranes, antenatal steroid, a higher rate of oxygen use, tracheal intubation at birth, and a lower incidence of out born (Table 1). As in Table 2, the erythropoietin group, compared to the control group, had a significantly higher rate of the primary outcome (ROP requiring treatment) and CLD while having a significantly lower rate of death, FIP, and NEC. The two groups did not differ in the composite outcomes of ‘death or ROP’ and ‘death or CLD’.Conclusion(s): The number of ROP requiring treatment was significantly higher in the erythropoietin group than in the control group. However, the higher death in the control group might be a reason for the lower rate of ROP because more infants died before developing ROP in the control group.
Table 1
Table 2