Erythropoietin and retinopathy of prematurity: a retrospective cohort study in Japan, 2008–2018

Background Erythropoietin has an angiogenic effect on the retina and might increase the risk of retinopathy of prematurity (ROP). Methods This retrospective cohort study included infants born at 22 to 27 weeks’ gestation between 2008 and 2018 who were admitted to neonatal intensive care units (NICUs). We compared mortality and morbidities between infants who received erythropoietin and those who did not. Results Among 18,955 livebirth infants, this study included 16,031 infants, among which 14,373 infants received erythropoietin. The risk of ROP requiring treatment was significantly higher in the erythropoietin group than in the control group (33% vs. 26%; aOR 1.50 [95% CI 1.28–1.76]). On the other hand, the erythropoietin group had lower risks of death and necrotizing enterocolitis. Conclusions This study with a large sample size found that erythropoietin use was associated with increased risk of ROP requiring treatment, while being associated with reductions in deaths and NEC.