ERYTHROPOIETIN THERAPY IN NEONATES AT RISK OF HAVING BRONCHOPULMONARYDYSPLASIA AND REQUIRING MULTIPLE TRANSFUSIONS

Objectives: To determine whether treatment with recombinant human eryt hropoietin (r-HuEPO) reduces transfusion requirements in premature neo nates at risk of having bronchopulmonary dysplasia and requiring multi ple transfusions. Study design: A double-blind, randomized, controlled trial. Subjects: Fifty-five infants appropriate in weight for gestati onal age (less than 1250 gm birth weight) who, at 10 days of age, were predicted to have a greater than 75% probability of having bronchopul monary dysplasia. This criterion had previously been shown to identify infants requiring multiple transfusions. Twenty-seven infants were ra ndomly assigned to receive r-HuEPO therapy and 28 to a control group, r-HuEPO was administered in a dosage of 200 U/kg body weight, subcutan eously, three times a week for 6 weeks, Control infants received sham treatment. Results: Infants treated with r-HuEPO required significantl y fewer transfusions than control infants during their entire hospital stay (mean 3.48 +/- 1.58 vs 5.68 +/- 2.30; p = 0.0001) and had a high er mean reticulocyte count (p less than or equal to 0.0005) and a high er mean hemoglobin concentration (p less than or equal to 0.005) durin g the treatmet period, At follow-up, 4 months after term, there were n o significant differences between the groups in mean reticulocyte coun t (p = 0.86) or mean hemoglobin concentration (p = 0.56). However, two infants in each group had low serum ferritin values indicative of dep leted iron stores. Conclusions: Treatment with r-HuEPO effectively sti mulated erythropoiesis in premature infants at high risk of having bro nchopulmonary dysplasia and requiring multiple transfusions; the resul t was a reduction in transfusion requirements. This treatment, togethe r with other strategies to reduce the need for transfusions, is approp riate in this population. Unrelated to r-HuEPO treatment, these infant s may be at risk of having iron deficiency later in infancy.