Neurodevelopmental outcome and growth at 18 to 22 months' corrected age in extremely low birth weight infants treated with early erythropoietin and iron.
BACKGROUND
Clinical trials evaluating the use of erythropoietin (Epo) have demonstrated a limited reduction in transfusions; however, long-term developmental follow-up data are scarce.


OBJECTIVE
We compared anthropometric measurements, postdischarge events, need for transfusions, and developmental outcomes at 18 to 22 months' corrected age in extremely low birth weight (ELBW) infants treated with early Epo and supplemental iron therapy with that of placebo/control infants treated with supplemental iron alone.


METHODS
The National Institute of Child Health and Human Development Neonatal Research Network completed a randomized, controlled trial of early Epo and iron therapy in preterm infants < or =1250 g. A total of 172 ELBW (< or =1000-g birth weight) infants were enrolled (87 Epo and 85 placebo/control). Of the 72 Epo-treated and 70 placebo/control ELBW infants surviving to discharge, follow-up data (growth, development, rehospitalization, transfusions) at 18 to 22 months' corrected age were collected on 51 of 72 Epo-treated infants (71%) and 51 of 70 placebo/controls (73%) by certified examiners masked to the treatment group. Statistical significance was determined using chi2 analysis.


RESULTS
There were no significant differences between treatment groups in weight or length or in the percentage of infants weighing <10th percentile either at the time of discharge or at follow-up, and no difference was found in the mean head circumference between groups. A similar percentage of infants in each group was rehospitalized (38% Epo and 35% placebo/control) for similar reasons. There were no differences between groups with respect to the percentage of infants with Bayley-II Mental Developmental Index <70 (34% Epo and 36% placebo/control), blindness (0% Epo and 2% placebo/control), deafness or hearing loss requiring amplification (2% Epo and 2% placebo/control), moderate to severe cerebral palsy (16% Epo and 18% placebo/control) or the percentage of infants with any of the above-described neurodevelopmental impairments (42% Epo and 44% placebo/control).


CONCLUSIONS
Treatment of ELBW infants with early Epo and iron does not significantly influence anthropometric measurements, need for rehospitalization, transfusions after discharge, or developmental outcome at 18 to 22 months' corrected age.
Ohls
Robin K
RK
Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA. rohls@unm.edu
Ehrenkranz
Richard A
RA
Das
Abhik
A
Dusick
Anna M
AM
Yolton
Kimberly
K
Romano
Elaine
E
Delaney-Black
Virginia
V
Papile
Lu-Ann
LA
Simon
Neal P
NP
Steichen
Jean J
JJ
Lee
Kimberly G
KG
D001766:Blindness / Q000453:epidemiology / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D049628:Body Size / Q000187:drug effects; D002547:Cerebral Palsy / Q000453:epidemiology / Q000517:prevention & control; D002657:Child Development / Q000187:drug effects*; D004311:Double-Blind Method; D004921:Erythropoietin / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006128:Growth / Q000187:drug effects; D006311:Hearing Disorders / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development; D019102:Infant, Very Low Birth Weight / Q000254:growth & development*; D007501:Iron / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D011596:Psychomotor Disorders / Q000453:epidemiology / Q000517:prevention & control
D004921:Erythropoietin; D007501:Iron