Related Experiment Video
Updated: Oct 22, 2025
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Endogenous erythropoietin at birth is associated with neurodevelopmental morbidity in early childhood
Elina J Rancken1, Marjo P H Metsäranta2, Mika Gissler3,4
1Children's Hospital, Pediatric Research Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. elina.rancken@helsinki.fi.
Insights
High umbilical cord serum erythropoietin (us-EPO) levels at birth may indicate a higher risk of neurodevelopmental morbidity in children. However, the clinical utility of us-EPO testing for predicting these outcomes appears limited.
Area of Science:
- Neonatal research
- Neurodevelopmental disorders
- Biomarker discovery
Background:
- There is a critical need for novel biomarkers to predict future neurodevelopmental morbidity in infants.
- Umbilical cord serum erythropoietin (us-EPO) is a potential candidate biomarker for assessing early life risks.
Purpose of the Study:
- To investigate the association between umbilical cord serum erythropoietin (us-EPO) levels at birth and the risk of neurodevelopmental morbidity up to 6.5 years of age.
- To evaluate the potential of us-EPO as a predictive biomarker for neurodevelopmental outcomes in a Finnish cohort.
Main Methods:
- A cohort of 878 non-anomalous children born between 2012-2016 had their us-EPO levels measured at birth.
- Neurodevelopmental morbidity diagnoses were ascertained through linkage with high-quality Finnish national registers.
- Gestational age and us-EPO levels were analyzed for correlations and associations with various neurodevelopmental conditions.
Main Results:
- Us-EPO levels correlated with gestational age, being lower in preterm infants.
- Elevated us-EPO levels (>100 IU/l) were associated with a significantly increased risk of severe neurodevelopmental morbidity (OR: 4.87) after adjusting for gestational age.
- No significant difference in the distribution of us-EPO levels was observed between children with and without later neurodevelopmental diagnoses.
Conclusions:
- While high us-EPO concentration at birth is linked to an increased risk of early childhood neurodevelopmental morbidity, its practical clinical value for prediction seems minor.
- Further research may be needed to fully elucidate the role and clinical applicability of us-EPO in neonatal risk assessment.
Background:
New biomarkers that predict later neurodevelopmental morbidity are needed. This study evaluated the associations between umbilical cord serum erythropoietin (us-EPO) and neurodevelopmental morbidity by the age of 2-6.5 years in a Finnish cohort.
Methods:
This study included 878 non-anomalous children born alive in 2012 to 2016 in Helsinki University Hospitals and whose us-EPO concentration was determined at birth. Data of these children were linked to data from the Finnish Medical Birth Register and the Finnish Hospital Discharge Register. Neurodevelopmental morbidity included cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, sensorineural defects, and minor neurodevelopmental disorders.
Results:
In the cohort including both term and preterm children, us-EPO levels correlated with gestational age (r = 0.526) and were lower in premature children. High us-EPO levels (>100 IU/l) were associated with an increased risk of severe neurodevelopmental morbidity (OR: 4.87; 95% CI: 1.05-22.58) when adjusted for the gestational age. The distribution of us-EPO levels did not differ in children with or without the later neurodevelopmental diagnosis.
Conclusions:
Although high us-EPO concentration at birth was associated with an increased risk of neurodevelopmental morbidity in early childhood, the role of us-EPO determination in clinical use appears to be minor.
Impact:
We determined whether endogenous umbilical cord serum erythropoietin would be a new useful biomarker to predict the risk of neurodevelopmental morbidity. This study evaluated the role of endogenous erythropoietin at birth in neurodevelopmental morbidity with a study population of good size and specific diagnoses based on data from high-quality registers. Although high umbilical cord serum erythropoietin concentration at birth was associated with an increased risk of neurodevelopmental morbidity in early childhood, the clinical value of erythropoietin determination appears to be minor.
Related Concept Videos
01:14Erythropoiesis
01:24Factors Affecting Erythropoiesis
Several factors influence the erythrocyte production rate, with tissue oxygen level being among the most critical. Intense exercise or high altitudes can cause tissue hypoxia, which triggers the kidneys to release more erythropoietin (EPO) into the bloodstream.
EPO then...
01:28Role of Hematopoietic Growth Factors
Thrombopoietin (TPO), mainly released by the liver,...
01:27Disorders of Erythrocytes
Erythrocyte disorders can be broadly categorized into two main types: anemic and polycythemic conditions.
A low oxygen-carrying capacity of the blood due to the loss, lower production, or destruction of erythrocytes is termed anemia. Hemorrhagic anemia, for example, occurs when bleeding from an external wound or internal ulcer reduces erythrocyte counts.
On the other...
01:37Neural Regulation