Enhancement of erythropoiesis by recombinant human erythropoietin in low birth weight infants: a pilot study.
We randomly assigned eight concurrently symptom-free premature infants (birth weight less than or equal to 1250 gm) at high risk of requiring erythrocyte transfusions for anemia of prematurity to 6 weeks of intensive treatment with either subcutaneous recombinant human erythropoietin (r-HuEPO group) or a placebo (control group). Treatment with r-HuEPO was initiated at a dose of 100 units/kg per day 5 days a week, and was increased to 200 units/kg per day after 2 or 3 weeks if target reticulocyte counts were not achieved. All patients were given supplemental oral iron therapy at a dose of 6 mg/kg per day, as tolerated. Mean reticulocyte counts in r-HuEPO-treated and control infants were 64,600 versus 67,500 cells/mm3 at entry; were 245,600 versus 78,000 cells/mm3 after 1 week; and averaged 262,600 versus 136,400 cells/mm3 during the study. Mean reticulocyte counts in r-HuEPO-treated infants were 251,200 cells/mm3 during the week when r-HuEPO, 100 units/kg per day, was given, and were 269,500 cells/mm3 after the dose was increased to 200 units/kg per day. Mean hematocrit values at entry were 33.4% in babies who received r-HuEPO versus 33.6% in the control subjects, and were 31.4% in r-HuEPO-treated and 25.2% in the control subjects at the end of treatment. One r-HuEPO-treated and three control babies received transfusions during the study; the total volume of blood given was 17 ml in the r-HuEPO group and 101 ml in the control subjects. The percentage of hemoglobin F increased in infants not given transfusions. We conclude that r-HuEPO stimulates endogenous erythropoiesis in small premature babies who are receiving supplemental oral iron therapy. A controlled multicenter trial has been undertaken to confirm these promising preliminary observations.
Shannon
K M
KM
Department of Pediatrics, University of California, San Francisco.
Mentzer
W C
WC
Abels
R I
RI
Wertz
M
M
Thayer-Moriyama
J
J
Li
W Y
WY
Thompson
D
D
Decelle
S
S
Phibbs
R H
RH
D000751:Anemia, Neonatal / Q000503:physiopathology / Q000628:therapy*; D001803:Blood Transfusion; D001835:Body Weight / Q000502:physiology; D017707:Erythrocyte Transfusion; D004920:Erythropoiesis / Q000502:physiology*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis; D006400:Hematocrit; D006801:Humans; D007230:Infant, Low Birth Weight / Q000502:physiology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D007501:Iron / Q000008:administration & dosage; D007958:Leukocyte Count; D008297:Male; D009504:Neutrophils; D010865:Pilot Projects; D010976:Platelet Count; D011897:Random Allocation; D011994:Recombinant Proteins / Q000008:administration & dosage; D012156:Reticulocytes
D011994:Recombinant Proteins; D004921:Erythropoietin; D005319:Fetal Hemoglobin; D007501:Iron