Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants

Comparison between one and three doses a week of recombinant erythropoietin in very low birth weight infants

“…[3][4][5][6][7] Since the first pilot trial, published by Halperin et al in 1990, 8 rEPO use has spread and many studies have evaluated it as safe and effective. [9][10][11][12] In terms of efficacy, rEPO stimulates erythropoiesis in VLBW infants and diminishes the number of transfusions per infant as well as the cumulative volume transfused and the exposure to multiple donors. [10][11][12] Nevertheless, habitual use has not been recommended because of the multifactorial causes of the anemia.…”

“…[9][10][11][12] In terms of efficacy, rEPO stimulates erythropoiesis in VLBW infants and diminishes the number of transfusions per infant as well as the cumulative volume transfused and the exposure to multiple donors. [10][11][12] Nevertheless, habitual use has not been recommended because of the multifactorial causes of the anemia. Control of phlebotomies and the use of strict transfusion criteria by themselves lower the transfusion requirement.…”

“…6,7 Regarding safety, long-term adverse effects are still unknown, 6 but in the short term, rEPO does not increase neonatal morbidity (sepsis, necrotizing enterocolitis, intraventricular hemorrhage, chronic lung disease, death before discharge, hypertension). [10][11][12] Nevertheless, because of its demonstrated angiogenic activity, 13 several trials have associated the use of rEPO with retinopathy of prematurity (ROP). 14,15 Current meta-analyses have shown greater ROP incidence in VLBW infants who received rEPO before day 8 of life.…”

“…14,15 Current meta-analyses have shown greater ROP incidence in VLBW infants who received rEPO before day 8 of life. [10][11][12] The most suitable dosage schedule, based on pharmacokinetic studies, remains unclear because of differences among studies. Controversy persists concerning dosages of rEPO and iron supplement, the route of administration, the best timing and duration for treatment.…”

Stimulating erythropoiesis in neonates

“…The initial motivation for trialing Epo in neonates was to reduce the number of donors that these patients were exposed to. A number of studies examining Epo administration in neonates have shown that there is some benefit to the use of these medications with a reduction of one to two transfusions in these patients [11,12]. The clinical utility of this reduction in transfusions is not clear.…”