Effect of early versus late administration of human recombinant erythropoietin on transfusion requirements in premature infants: results of a randomized, placebo-controlled, multicenter trial.
OBJECTIVE
The administration of recombinant human erythropoietin (rHuEPO), started after the first 2 weeks of life, reduces the transfusion requirement in premature infants. However, its use throughout the first 2 weeks of life, when anemia results predominantly from phlebotomy losses, remains controversial. We investigated whether early use of rHuEPO would reduce the total transfusion requirement and/or the number of transfusions throughout the first 2 weeks of life.


METHODS
We randomized 114 infants with birth weight (BW) <1250 g to receive rHuEPO (1250 units/kg/week; IV; early group: n = 57) or placebo (late group: n = 57) from day 2 to day 14 of life; subsequently, all the patients received rHuEPO (750 units/kg/week, subcutaneously) for 6 additional weeks. All infants were given oral iron (6 mg/kg/day) and folic acid (2 mg/day).


RESULTS
The early group showed higher hematocrit and reticulocyte counts than the late group in the first 3 weeks of life, but there was no difference in the total number of transfusions (early: 1.8 +/- 2.3 vs late: 1.8 +/- 2.5 transfusion/patient) or the transfusion requirement throughout the first 2 weeks of life (early:.8 +/- 1.1 vs late:.9 +/- 1.3) could be demonstrated. In infants with BW <800 g and total phlebotomy losses >30 mL/kg (n = 29), a lower number of transfusions was received by infants in the early group, compared with late group, from the second week to the end of the treatment (early: 3.4 +/- 1.1 vs late: 5.4 +/- 3.7 transfusion/patient). No clinical adverse effects were observed. Thrombocytosis was detected during the treatment with rHuEPO in 31% of the infants.


CONCLUSIONS
In the whole population, the early administration of rHuEPO induced a rise of reticulocyte counts, but not enough to reduce the transfusion requirement. The most severely ill infants (BW <800 g and phlebotomy losses >30 mL/kg) seemed to benefit from early use of rHuEPO, and this deserves additional study.
Donato
H
H
Clinical Research Area, Bio Sidus S.A. Laboratory, Buenos Aires, Argentina. h.donato@biosidus.com.ar
Vain
N
N
Rendo
P
P
Vivas
N
N
Prudent
L
L
Larguía
M
M
Digregorio
J
J
Vecchiarelli
C
C
Valverde
R
R
García
C
C
Subotovsky
P
P
Solana
C
C
Gorenstein
A
A
D000751:Anemia, Neonatal / Q000097:blood / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D004921:Erythropoietin / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000517:prevention & control*; D007501:Iron / Q000627:therapeutic use; D011994:Recombinant Proteins; D013997:Time Factors
D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron