BACKGROUND Recombinant human erythropoietin (rhEPO) lost its role in minimizing red blood cell transfusion in very preterm infants after it had been associated with severe retinopathy of prematurity (ROP). Previous systematic reviews did not stratify ROP by gestation and birth weight (BW). OBJECTIVES The aim of this study was to investigate the effect of early prophylactic rhEPO on ROP in a stratified meta-analysis of randomized controlled trials (RCTs). METHODS The databases EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched in January 2022 and complemented by citation searching. RCTs comparing early rhEPO treatment with no treatment or placebo were selected if they were published in a peer-reviewed journal and reported ROP outcomes. Previously unpublished data were requested from the study authors to allow stratified analyses by gestational age (GA) and BW. Data were extracted and analyzed using the standard methods of the Cochrane Neonatal Review Group. Pre-specified outcomes were "ROP stage ≥3" (primary outcome) and "any ROP." RESULTS Fourteen RCTs, comprising 2,040 infants of <29 weeks of GA, were included for meta-analysis. Data syntheses showed no effects of rhEPO on ROP stage ≥3 or on any ROP, neither in infants of <29 weeks GA, nor in infants of <1,000 g BW, nor in any GA strata. The risk ratio (95% confidence interval) for ROP stage ≥3 in infants of <29 weeks of GA was 1.13 (0.84, 1.53), p = 0.41 (quality of evidence: moderate). CONCLUSIONS The present meta-analysis detected no effects of early rhEPO on ROP in any comparison, but most stratified analyses were limited by low statistical power.

中文翻译：

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早期促红细胞生成素对早产儿视网膜病变的影响：分层荟萃分析。

背景重组人促红细胞生成素（rhEPO）在与严重早产儿视网膜病变（ROP）相关后，失去了在极早产儿中最大限度地减少红细胞输注的作用。之前的系统评价并未按妊娠期和出生体重 (BW) 对 ROP 进行分层。目的 本研究的目的是通过随机对照试验 (RCT) 的分层荟萃分析探讨早期预防性 rhEPO 对 ROP 的影响。方法 数据库 EMBASE、MEDLINE 和 Cochrane 对照试验中心注册库于 2022 年 1 月进行检索，并通过引文检索进行补充。如果随机对照试验发表在同行评审期刊上并报告了 ROP 结果，则将选择比较早期 rhEPO 治疗与不治疗或安慰剂的随机对照试验。研究作者要求提供之前未发表的数据，以便按胎龄 (GA) 和体重进行分层分析。使用 Cochrane 新生儿审查组的标准方法提取和分析数据。预先指定的结果为“ROP ≥3 期”（主要结果）和“任何 ROP”。结果 14 项 RCT 纳入荟萃分析，其中包括 2,040 名 GA <29 周的婴儿。数据综合显示，rhEPO 对 ROP ≥ 3 期或任何 ROP 没有影响，无论是在 GA <29 周的婴儿中，还是在体重 <1,000 g 的婴儿中，也没有在任何 GA 层中。GA <29 周的婴儿 ROP ≥3 期的风险比（95% 置信区间）为 1.13 (0.84, 1.53)，p = 0.41（证据质量：中等）。结论 目前的荟萃分析在任何比较中均未检测到早期 rhEPO 对 ROP 的影响，但大多数分层分析受到低统计功效的限制。