Recombinant erythropoietin and blood transfusion in selected preterm infants.
OBJECTIVE
To comprehensively identify preterm infants likely to require blood transfusion and to investigate the effectiveness of recombinant erythropoietin in this high risk subgroup.


METHODS
Double blind randomised controlled trial.


METHODS
Neonatal Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand.


METHODS
Preterm infants < 33 weeks gestation and < 1700 g birth weight meeting specific criteria indicating a high possibility of requiring blood transfusion.


METHODS
Predictors of blood transfusion were determined by analysis of preterm infants admitted to a neonatal intensive care unit over a two year period. Using the criteria developed, high risk infants entered the study and received erythropoietin or sham treatment until 34 weeks completed gestation. The sample size was calculated to detect a reduction of one blood transfusion per infant (significance level 5%, power 80%).


RESULTS
The selection criteria had a positive predictive value for transfusion of 91% and a negative predictive value of 94%. Mean birth weights and gestational ages were similar in the two groups. Absolute reticulocyte counts and haemoglobin values were higher in the group receiving erythropoietin. There was no significant difference in the number of blood transfusions received in the treatment and control groups. However, comparing transfusions given to < 1000 g infants after 30 days of age, there were significantly fewer transfusions in the erythropoietin group (mean (SD) 0.5 (0.7) in those receiving erythropoietin and 1.6 (1.1) in the controls). No adverse effects were noted.


CONCLUSIONS
The selection criteria for the study were highly predictive of subsequent transfusion. In the group receiving erythropoietin, a reduction in transfusion requirements was apparent only in the < 1000 g birthweight group after 1 month of age.
Meyer
M P
MP
Neonatal Unit, Kidz First, Middlemore Hospital and the University of Auckland, New Zealand. mmeyer@middlemore.co.nz
Sharma
E
E
Carsons
M
M
D001772:Blood Cell Count; D001782:Blood Donors; D001803:Blood Transfusion; D004311:Double-Blind Method; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008297:Male; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin