PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1066-1072
Effect of Early Versus Late Administration of Human Recombinant Erythropoietin on Transfusion Requirements in Premature Infants: Results of a Randomized, Placebo-Controlled, Multicenter Trial
Received Mar 24, 1999; accepted Aug 2, 1999.
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From the * Clinical Research Area, Bio Sidus S. A.;
Department of Pediatrics, Sanatorio de la Trinidad; § Department of
Neonatology, Clínica y Maternidad Suizo-Argentina;
Department of Neonatology, Instituto Médico de Obstetricia;
¶ Department of Neonatology, Sanatorio Otamendi; # Department of
Neonatology, Clínica del Sol; ** Department of Neonatology,
Sanatorio Jockey Club; and Department of Neonatology,
Clínica Independencia, Buenos Aires, Argentina.
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. Key words: erythropoietin, anemia, prematurity, transfusion, thrombocytosis.
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