THE BEST TIMING OF RECOMBINANT-HUMAN-ERYTHROPOIETIN ADMINISTRATION INANEMIA OF PREMATURITY - A RANDOMIZED CONTROLLED-STUDY

Recombinant human erythropoietin (rHuEPO) treatment successfully preve nts anemia of prematurity during the period when it is administered. H owever, data on the duration and optimal timing of rHuEPO administrati on are unavailable. A total of 85 neonates with birth weight less than or equal to 1500 g, gestational age less than or equal to 31 weeks we re entered in a controlled study of rHuEPO administration. Of these, 5 0 neonates (group A) were randomly assigned to take rHuEPO (3 x 250 U/ kg/wk subcutaneously) (n = 24) or no rHuEPO (control n = 26), early af ter birth (3 to 7 days) for 6 weeks. Retrospectively, these neonates w ere classified into those without (n = 22) and with complications (n = 28) (mechanical ventilation If: sepsis). Subsequently 35 neonates (gr oup B) were randomly assigned to take rHuEPO (3 x 200 U/kg/wk subcutan eously) (n = 20) or no rHuEPO (control n = 15) after their problems ha d been resolved and when they were receiving full enteral feeding. Hem atologic parameters, transfusion requirements and growth were followed during the entire hospitalization period. Reticulocyte counts during rHuEPO treatment were significantly higher in all rHuEPO recipients co mpared with their controls. Regarding transfusions, infants with compl ications did not benefit from rHuEPO administration [erythropoietin (E PO) neonates: 5 +/- 2.5, control neonates: 4.9 +/- 1.4] whereas both n eonates without complications in group A (EPO neonates: 0.2 +/- 0.4, c ontrol neonates: 1 +/- 0.7) and neonates in group B (EPO neonates: 0.4 +/- 0.9, control neonates: 1.8 +/- 1.3) received significantly fewer blood transfusions during rHuEPO administration. In conclusion rHuEPO should be administered only in neonates without complications or when complications have been resolved and full enteral feeding has been est ablished. We suggest that rHuEPO therapy should be given until neonate s ape discharged from the hospital.