Recombinant human erythropoietin in anemia of prematurity

Objective: To evaluate safety and efficacy of recombinant human erythropoietin (r-HuEPO) in reducing the need for red cell transfusions in anemia of prematurity. Methods: Forty-two preterm infants (gestational age ≤32 weeks) were randomly assigned to a 'treatment' group (r-HuEPO 400 units/kg every alternate day x 10 doses) or 'no treatment' (control) group. All infants on enteral feeds received oral iron 3 mg/kg/day, graded up to 6 mg/kg/day. Results: Higher reticulocyte counts in week 2 and 3 and higher hemoglobin levels in week 4 were noted after treatment with r-HuEPO. Despite stimulated erythropoiesis, the frequency of transfusions could not be reduced with r-HuEPO therapy. Overall, phlebotomy losses, frequency and volume of red-cell transfusions were significantly more in neonates with birthweight ≤1000 grams compared with those with birthweight >1000 grams (p < 0.05). Associated side effects of r-HuEPO such as neutropenia, sepsis, hypertension or increased risk of late death did not occur. Conclusions: r-HuEPO therapy was safe without any side effects. Inability of r-HuEPO therapy to minimize red-cell transfusions for anemia of prematurity may be explained by a relatively strict red-cell transfusion policy and the desired degree of treatment effect.