Effects of a combined therapy of erythropoietin, iron, folate, and vitamin B12 on the transfusion requirements of extremely low birth weight infants.
OBJECTIVE
Erythropoietin is frequently administered to premature infants to stimulate erythropoiesis. The primary goal of erythropoietin therapy is to reduce transfusions, but the efficacy of erythropoietin has not been convincingly demonstrated in this regard. The aim of this trial was to investigate whether combined administration of vitamin B12, folic acid, iron, and erythropoietin could decrease transfusion requirements in extremely low birth weight infants.


METHODS
In a randomized, controlled trial, extremely low birth weight infants with a birth weight < or = 800 g and a gestational age < or = 32 weeks were randomly assigned to a group receiving combination treatment or a control arm.


RESULTS
The treatment increased levels of folate in red blood cells, vitamin B12, ferritin, transferrin receptor levels in plasma, and reticulocyte counts. The proportion of infants requiring no transfusions was lower in the treatment group (38%) as compared with controls (5%). The treatment group and the need for mechanical ventilation were independent predictors of the number of transfusions in multiple regression analysis. Cox regression analysis indicated that combined therapy resulted in a 79% risk reduction for any transfusion.


CONCLUSIONS
Combined treatment with erythropoietin, intravenous iron, folate, and vitamin B12 during the first weeks reduces the need for transfusion in extremely low birth weight infants.
Haiden
Nadja
N
Department of Pediatrics, Division of Neonatology and Intensive Care, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. nadja.haiden@meduniwien.ac.at
Schwindt
Jens
J
Cardona
Francesco
F
Berger
Angelika
A
Klebermass
Katrin
K
Wald
Martin
M
Kohlhauser-Vollmuth
Christina
C
Jilma
Bernd
B
Pollak
Arnold
A
D001803:Blood Transfusion / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D014805:Vitamin B 12 / Q000627:therapeutic use*
D004921:Erythropoietin; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12