Reduction of brain damage after perinatal arterial stroke (PAS) with recombinant human erythropoietine (rhEPO): "feasibility" and "safety study".

Cereral arterial stroke in the perinatal period has an incidence of 1/3000-4000
in newborns. PAS causes abnormal cognitive and neuromotor development and
outcome in 30-57%. This complication is therefore an important 'target' for
therapy for reduction of reduction of braindamage. Recently a study described
adults treated for stroke with rhEPO 900IU/kg, without side-effects, had a
significant better outcome compared to placebo-treated group, without side
effects of rhEPO.
The neuroprotective activity of rhEPO (neurotroph, angiogenesis,
anti-inflammatory, anti-apoptic activity) was already shown in animal
experimental research. It showed that rhEPO is effective in case of global
hypoxic-ischemia as well as focal cerebral ischemia of the middle cerebral
artery with a reduction of the size of the stroke up to 40%. Furthermore, rhEPO
has been clinically used for anemia in preterm born infants, with a dosages
until 700 IU/kg and even higher during a prolonged period of time (4 - 8 wks)
without side effects.

To investigate if rhEPO has a positive effect on MRI/MRA parameters compared to
infants with stroke without rhEPO collected from historical data.
To investigate if rhEPO (3 dosages of 1000IU/kg/day) for perinatal stroke has
no negative side-effects on red bloodcell count or clotting system,
bloodpressure, edema.

All newborn infants with a gestational age of 36 wks admitted to our Neonatal
Intesive Care Unit with the diagnosis perinatal arterial stroke (PAS) diagnosed
with cerebral ultrasound or MRI/MRA. Chormosomal/congenital abnormalities are
exclusion criteria.
Immediately after the diagnosis and parental consent rhEPO (1000IU/kg, iv) will
be given, repeated after 24 h and 48h. Historical data will be used for
comparison.
MRI/MRA will be performed to confirm the diagnosis, this will be repeated after
1 week and after 3 months. This is routine clinical care.

Immediately after the diagnosis and parental consent rhEPO (1000IU/kg, iv) will
be given, repeated after 24 h and 48h. Historical data will used as a control
group.

MRI/MRA is routine clinical care in patients with PAS.
Extra bloodsample during routine clinical blood withdrawals, for isoprostane,
Non-protein bound iron.