title: Iron supplementation enhances response to high doses of recombinant human erythropoietin in preterm infants.
abstract: OBJECTIVE
  To determine whether iron supplementation would enhance erythropoiesis in preterm infants treated with high doses of human recombinant erythropoietin (r-HuEPO).
  
  
  METHODS
  Sixty three preterm infants were randomly allocated at birth to one of three groups to receive: r-HuEPO alone, 1200 IU/kg/week (EPO); or r-HuEPO and iron, 1200 IU/kg/week of r-HuEPO plus 20 mg/kg/week of intravenous iron (EPO + iron); or to serve as controls. All three groups received blood transfusions according to uniform guidelines.
  
  
  RESULTS
  Infants in the EPO + iron group needed fewer transfusions than controls--mean (95% CI) 1.0 (0.28-1.18) vs 2.9 (1.84-3.88) and received lower volumes of blood--mean (95% CI) 16.7 (4.9-28.6) vs 44.4 (29.0-59.7) ml/kg. The EPO group also needed lower volumes of blood than the controls--mean (95% CI) 20.1 (6.2-34.2) vs 44.4 (29.0-59.7) ml/kg, but the same number of transfusions, 1.3 (0.54-2.06) vs 2.9 (1.84-3.88). Reticulocyte and haematocrit values from postnatal weeks 5 to 8 were higher in the EPO + iron than in the EPO group, and both groups had higher values than the controls. Mean (SEM) plasma ferritin was lower in the EPO group-65 (55) micrograms/l than in the EPO + iron group 780 (182) micrograms/l, and 561 (228) micrograms/l in the control infants.
  
  
  CONCLUSIONS
  Early administration of high doses of r-HuEPO with iron supplements significantly reduced the need for blood transfusion. Intravenous iron (20 mg/kg/week in conjunction with r-HuEPO yielded a higher reticulocyte count and haematocrit concentration after the forth week of life than r-HuEPO alone. Infants treated with r-HuEPO alone showed signs of reduced iron stores.
authors.affiliation: Department of Paediatrics, University of Padova, Italy. carnielli@child.pedi.unipd.it
authors.forename: V P
authors.initials: VP
authors.lastname: Carnielli
authors.forename: R
authors.initials: R
authors.lastname: Da Riol
authors.forename: G
authors.initials: G
authors.lastname: Montini
mesh_terms: D001803:Blood Transfusion; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000627:therapeutic use*; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007501:Iron / Q000008:administration & dosage* / Q000378:metabolism; D011994:Recombinant Proteins; D017701:Reticulocyte Count; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron