Erythropoietin therapy in neonates at risk of having bronchopulmonary dysplasia and requiring multiple transfusions.
OBJECTIVE
To determine whether treatment with recombinant human erythropoietin (r-HuEPO) reduces transfusion requirements in premature neonates at risk of having bronchopulmonary dysplasia and requiring multiple transfusions.


METHODS
A double-blind, randomized, controlled trial.


METHODS
Fifty-five infants appropriate in weight for gestational age (less than 1250 gm birth weight) who, at 10 days of age, were predicted to have a greater than 75% probability of having bronchopulmonary dysplasia. This criterion had previously been shown to identify infants requiring multiple transfusions. Twenty-seven infants were randomly assigned to receive r-HuEPO therapy and 28 to a control group. r-HuEPO was administered in a dosage of 20 U/kg body weight, subcutaneously, three times a week for 6 weeks. Control infants received sham treatment.


RESULTS
Infants treated with r-HuEPO required significantly fewer transfusions than control infants during their entire hospital stay (mean 3.48 +/- 1.58 vs 5.68 +/- 2.30; p = 0.0001) and had a higher mean reticulocyte count (p < or = 0.0005) and a higher mean hemoglobin concentration (p < or = 0.005) during the treatment period. At follow-up, 4 months after term, there were no significant differences between the groups in mean reticulocyte count (p = 0.86) or mean hemoglobin concentration (p = 0.56). However, two infants in each group had low serum ferritin values indicative of depleted iron stores.


CONCLUSIONS
Treatment with r-HuEPO effectively stimulated erythropoiesis in premature infants at high risk of having bronchopulmonary dysplasia and requiring multiple transfusions; the result was a reduction in transfusion requirements. This treatment, together with other strategies to reduce the need for transfusions, is appropriate in this population. Unrelated to r-HuEPO treatment, these infants may be at risk of having iron deficiency later in infancy.
Al-Kharfy
T
T
Department of Paediatrics and Pathology, University of British Columbia, Vancouver, Canada.
Smyth
J A
JA
Wadsworth
L
L
Krystal
G
G
Fitzgerald
C
C
Davis
J
J
Milner
R
R
D001997:Bronchopulmonary Dysplasia / Q000097:blood*; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin