rhEPO Reduces Anemia in Extremely Low Birth Weight Infants

Laurie Barclay, MD

July 22, 2002

July 22, 2002 -- Early treatment with recombinant erythropoietin beta (rhEPO) reduces anemia and the need for blood transfusions in extremely low birth weight (ELBW) infants, according to the results of a blinded, randomized study reported in the July issue of the Journal of Pediatrics.

"Our hypotheses were that rhEPO increases hematocrit and decreases the need for transfusion in infants with birth weights below 1000 g and that the early start of treatment (in the first week of life) is more effective than a late start (in the fourth week)," write Rolf F. Maier, MD, and colleagues from the fourth European Multicenter Erythropoietin Beta Trial, which was supported by F. Hoffmann-La Roche.

In this study, 219 ELBW infants were randomized on day three to one of three groups: the early rhEPO group, which received 750 IU/kg/week from the first week for nine weeks; the late rhEPO group, which received the same dose but started on the fourth week for six weeks; or the control group, which did not receive rhEPO. All infants also received enteral iron (3-9 mg/kg/day) from the first week.

Rate of success, defined as no transfusion and hematocrit levels never below 30%, was 13% in the early rhEPO group, 11% in the late rhEPO group, and 4% in the control group ( P=.026 for early rhEPO vs. control group). Median transfusion volume was 0.4 mL/kg/day in the early rhEPO group, 0.5 mL/kg/day in the late rhEPO group, and 0.7 mL/kg/day in the control group ( P=.02).

"Infection risk was not increased and weight gain was not delayed with rhEPO beta," the authors write. "Early rhEPO beta treatment effectively reduces the need for transfusion in ELBW infants."

In an accompanying editorial, Robin K. Ohla, MD, from the University of New Mexico in Albuquerque, points out that perhaps more should be done to keep the blood in the infant by reducing phlebotomy: "Continued critical evaluation of transfusion criteria, outcomes, new technologies limiting phlebotomy loss, and novel biologic treatments can only serve to improve the care of ELBW infants who are at the highest risk for repeated transfusions."

J Pediatr. 2002;141(1):1-6, 8-15

Reviewed by Gary D. Vogin, MD

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