The use of erythropoietin and magnesium sulphate for the management of hypoxic-ischaemic encephalopathy in Lagos, Nigeria: A randomized control trial
Background: Therapeutic hypothermia is the recommended treatment for moderate-to-severe hypoxic-ischemic encephalopathy (HIE) in newborns. It is not readily available in low- and middle-income countries. Newer promising interventions include erythropoietin (EPO) and magnesium sulfate (MgSO4). This s...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2025-04-01
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| Series: | Journal of Clinical Sciences |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/jcls.jcls_82_24 |
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| Summary: | Background:
Therapeutic hypothermia is the recommended treatment for moderate-to-severe hypoxic-ischemic encephalopathy (HIE) in newborns. It is not readily available in low- and middle-income countries. Newer promising interventions include erythropoietin (EPO) and magnesium sulfate (MgSO4). This study evaluated the short-term effects of EPO and MgSO4 in the management of term infants with severe perinatal asphyxia.
Methods:
This was a randomized control trial conducted in the neonatal wards of two tertiary hospitals in Lagos over a 2-year period. Term neonates diagnosed with moderate-to-severe HIE at admission were randomized to receive either EPO (34 infants), MgSO4 (45 infants), or placebo care according to the unit protocol (29 infants). Survivors were followed up for 2 years for neurodevelopmental delay. The neonatal outcomes of the participants were presented here. Descriptive statistics were employed to analyze data using Stata version 16.
Results:
There were 107 participants; 69% were males, and 76.6% were outborn. The mean gestational age and birthweight were 38.6 (±2.4) weeks and 3000 (±677) g, respectively. The mean age at intervention was 19.0 (10–30) h. Four neonates had HIE 1, 73, HIE 2, and 30 had HIE 3. Only 14 babies received intervention drugs within 6 h of birth. Thirty-eight (35.5%) neonates died. Survival was significantly higher in infants treated with MgSO4 (34/45, 75.6%) compared to the placebo group (14/28, 50.0%, P = 0.03) but not in the EPO group (21/34, 61.8%, P = 0.32). The MgSO4 group had a higher decline in the risk ratio (RR) of neurological abnormalities compared to placebo (AdjRR: 0.34, 95% CI: 0.09–0.93, P = 0.007).
Conclusion:
Neonates with HIE had a better short-term outcome when treated with MgSO4 compared to placebo. |
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| ISSN: | 2468-6859 2408-7408 |