title: Preschool Assessment of Preterm Infants Treated With Darbepoetin and Erythropoietin.
abstract: BACKGROUND
  We previously reported improved neurodevelopmental outcomes at 2 years among infants treated with the erythropoiesis-stimulating agents (ESAs) darbepoetin alfa (darbepoetin) or erythropoietin. Here we characterize 4-year outcomes.
  
  
  METHODS
  Former preterm infants randomly assigned to receive darbepoetin (10 μg/kg, once per week), erythropoietin (400 U/kg, 3 times/week), or placebo through 35 weeks' postconceptual age were evaluated at 3.5 to 4 years of age. For comparison, healthy children formerly delivered full term (term controls [TCs]) were also recruited. All participants were assessed by using measures of full-scale IQ (FSIQ) and general language from the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, and an overall measure of executive function, on the basis of tests evaluating inhibitory control and spatial working memory. Rates of neurodevelopmental impairment were compared across groups.
  
  
  RESULTS
  Multivariate analysis of variance compared children randomly assigned to ESAs (n = 39), placebo (n =14), and TCs (n = 24). FSIQ and performance IQ were significantly higher in the ESA group than in the placebo group (FSIQ: 91.1 ± 17.5 vs 79.2 ± 18.5, P = .036; performance IQ: 93.0 ± 17.0 vs 79.5 ± 19.5, P = .018). Follow-up analyses revealed that the children receiving ESAs performed better than those who received placebo on executive function tasks. The ESA group's performance was below that of TCs, but the results did not reach significance on executive function. The incidence of neurodevelopmental impairment was greater in the placebo group than in the ESA group.
  
  
  CONCLUSIONS
  ESA-treated infants had better cognitive outcomes and less developmental impairment at 3.5 to 4 years of age compared with placebo-treated infants. ESAs show promise in improving long-term cognitive outcomes of infants born prematurely.
authors.affiliation: Departments of Pediatrics, rohls@salud.unm.edu.
authors.forename: Robin K
authors.initials: RK
authors.lastname: Ohls
authors.affiliation: Internal Medicine.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cannon
authors.affiliation: Neurology.
authors.forename: John
authors.initials: J
authors.lastname: Phillips
authors.affiliation: Mind Research Network, Albuquerque, New Mexico;
authors.forename: Arvind
authors.initials: A
authors.lastname: Caprihan
authors.affiliation: Department of Pediatrics and.
authors.forename: Shrena
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Pediatrics and.
authors.forename: Sarah
authors.initials: S
authors.lastname: Winter
authors.affiliation: Utah State Department of Health, Salt Lake City, Utah.
authors.forename: Michael
authors.initials: M
authors.lastname: Steffen
authors.affiliation: Psychology, and.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Yeo
authors.affiliation: Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico;
authors.forename: Richard
authors.initials: R
authors.lastname: Campbell
authors.affiliation: Department of Pediatrics and.
authors.forename: Susan
authors.initials: S
authors.lastname: Wiedmeier
authors.affiliation: Center for Clinical and Translational Science, University of Utah, Salt Lake City, Utah; and.
authors.forename: Shawna
authors.initials: S
authors.lastname: Baker
authors.affiliation: Mind Research Network, Albuquerque, New Mexico;
authors.forename: Sean
authors.initials: S
authors.lastname: Gonzales
authors.affiliation: Departments of Pediatrics.
authors.forename: Jean
authors.initials: J
authors.lastname: Lowe
mesh_terms: D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D003071:Cognition / Q000187:drug effects*; D000068256:Darbepoetin alfa / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D007279:Injections, Subcutaneous; D008297:Male; D065886:Neurodevelopmental Disorders / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D004921:Erythropoietin; D000068256:Darbepoetin alfa