Impact of Erythropoiesis-Stimulating Agents on Behavioral Measures in Children Born Preterm

• Published in: The Journal of pediatrics Vol. 184; pp. 75 - 80.e1
• Main Authors: Lowe, Jean R., PhD, Rieger, Rebecca E., MS, Moss, Natalia C., MS, Yeo, Ronald A., PhD, Winter, Sarah, MD, Patel, Shrena, MD, Phillips, John, MD, Campbell, Richard, PhD, Baker, Shawna, RN, Gonzales, Sean, BS, Ohls, Robin K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Child Behavior - drug effects; Child, Preschool; cognitive development; darbepoetin; Darbepoetin alfa - pharmacology; Emotions - drug effects; erythropoietin; Erythropoietin - pharmacology; Family Characteristics; Female; Hematinics - pharmacology; Humans; Infant, Newborn; Infant, Premature; Male; neurodevelopmental outcome; Pediatrics; Socioeconomic Factors; very low birth weight; Epo; Erythropoiesis-stimulating agents; very low birth weight; BASC-2; SEC; ESA; Darbe; neurodevelopmental outcome; cognitive development; Behavioral Assessment System of Children – Second Edition; Socioeconomic Composite; Darbepoetin alfa; darbepoetin; erythropoietin
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2017.01.020

Objective To evaluate the impact of erythropoiesis-stimulating agents (ESAs) administered during initial hospitalization and family demographic factors on behavior at 3.5-4 years of age. Study design Children were enrolled who had previously participated in a randomized study of ESAs (n = 35) or placebo (n = 14) in infants born preterm with birth weights of 500-1250 g. A term healthy control group (n = 22) also was recruited. Behavior was evaluated by parent report with the Behavioral Assessment System of Children-2. Principal component analyses identified 2 demographic factors, a Socioeconomic Composite (SEC) and a Family Stress Composite. A multivariate general linear model evaluated the impact of study group and sex on the 4 composite scales of the Behavioral Assessment System of Children-2. Demographic factors were treated as covariates and interactions with study group (ESA, placebo, and term) were examined. Results The ESA group had significantly better scores than the placebo group on behavioral symptoms ( P  = .04) and externalizing scales ( P  = .04). An interaction was observed between study group and SEC ( P  = .001). A beneficial effect of ESAs was maximal in the children with lower SEC scores. Conclusions The beneficial effects of ESAs on childhood behavior were maximal in children with lower SEC scores. ESAs seemed to ameliorate the adverse impact of lower SEC on behavioral domains seen in the placebo group. This effect was independent of the beneficial effect of ESAs on global cognition we reported previously. Trial registration ClinicalTrials.gov : NCT01207778 and NCT00334737.