The role of high-dose oral iron supplementation during erythropoietin therapy for anemia of prematurity.
OBJECTIVE
To assess whether a high intake of oral iron would increase the effect of recombinant human erythropoietin (rHuEPO) on hemoglobin synthesis.


METHODS
We studied 30 preterm infants (gestational age 29+/-1.8 weeks, birth weight 1161+/-200 g, at age of 28+/-10 days) who were randomly assigned to receive either 8 mg/kg per day (n=15) or 16 mg/kg per day of oral iron during a course of rHuEPO therapy (900 microg/kg per week) for a duration of 4 weeks. Both groups were comparable in regard to clinical and laboratory data at the time of enrollment.


RESULTS
rHuEPO caused a significant increase in reticulocyte count in the low- and high-dose iron groups, 17.1+/-5.3 to 34.7+/-9.2 and 16.3+/-3.3 to 42.5+/-5.6 (10(9)/l), respectively (p<0.05). However, in both groups, hematocrit values remained stable at the end of the study as compared to baseline (0.35+/-0.03% vs. 0.30+/-0.03%, 0.35+/-0.05% vs. 0.30+/-0.03%, NS) and in both groups there was a comparable and significant decrease in ferritin level (259+/-109 to 101+/-40 and 168+/-54 to 69+/-38 microg/l, respectively; p<0.01). The rates of bloody stools without any evidence of necrotizing enterocolitis were not significantly different between the two treatment groups (1/15 vs. 4/15, NS).


CONCLUSIONS
We conclude that a higher dose (16 mg/kg per day) of oral iron is not more beneficial when compared to a lower dose (8 mg/kg per day) during rHuEPO therapy for anemia of prematurity. Further studies will define the optimal dosage and route of administration of iron supplementation during rHuEPO therapy.
Bader
D
D
Department of Neonatology, Bnai-Zion Medical Center, B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Kugelman
A
A
Maor-Rogin
N
N
Weinger-Abend
M
M
Hershkowitz
S
S
Tamir
A
A
Lanir
A
A
Attias
D
D
Barak
M
M
D000284:Administration, Oral; D000704:Analysis of Variance; D000751:Anemia, Neonatal / Q000097:blood / Q000628:therapy*; D004357:Drug Synergism; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000097:blood; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000628:therapy*; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron