NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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Early Erythropoietin Treatment
Early treatment with erythropoietin ameliorates anemia and reduces transfusion requirements in infants with birth weights below 1000 g. Maier RF, Obladen M, Müller-Hansen I, et al. J Pediatr (July 2002);141:8-15.
In a blinded multicenter trial, 219 ELBW infants were randomized on day 3 to one of 3 groups: early rhEPO group (rhEPO from the first week for 9 weeks, n = 74), late rhEPO group (rhEPO from the fourth week for 6 weeks, n = 74), or control group (no rhEPO, n = 71). All infants received enteral iron (3-9 mg/kg/day) from the first week. The rhEPO dose was 750 IU/kg/week. Success was defined as no transfusion and hematocrit levels never below 30%.
Results: Success rate was 13% in the early rhEPO group, 11% in the late rhEPO group, and 4% in the control group (P = .026 for early rhEPO versus control group). Median transfusion volume was 0.4 versus 0.5 versus 0.7 mL/kg/day (P = .02) and median donor exposure was 1.0 versus 1.0 versus 2.0 (P = .05) in the early rhEPO group, the late rhEPO group, and the control group, respectively. Infection risk was not increased and weight gain was not delayed with rhEPO.
Conclusion: Early rhEPO treatment effectively reduces the need for transfusion in ELBW infants.
Comment. The study was not able to demonstrate a statistically significant reduction in the number of blood transfusions between groups. It was only by looking at transfusion volume or the combined end-point of no transfusions and no hematocrit < 30 did the results reach statistical significance. There is little question that rhEPO works in stimulating RBC production in premature infants. I‘m just not convinced that the degree of the effect justifies the cost, pain and risks associated with the treatment. Other ways to minimize the need for blood transfusions in premature infants include delayed cord clamping (See
3-019 and 1-024), early iron supplementation (see 1-028), and minimizing blood draws. ABKDate: 15 Aug 2002
Time: 06:13:02
Hmm...I agree. I have a real roblem with using epo in the ELBW baby.
Minimizing blood draws goes a long way toward preventing the need for a
transfusion. Also, most of these babies require a transfusion due to iatrogenic
blood loss and it occurs in the first week or two, well before the epo has had time to
make a difference. What about cost:benefit ratio? Does it make sense
economically to do this when there isn't a demonstrated statistical benefit?
UserName: Wendy McKenney
Institution: Dartmouth-Hitchcock Medical Center
telephone: 603-650-5000
email: mck@hitchcock.org
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