A COMPARISON OF ORAL AND INTRAVENOUS IRON SUPPLEMENTATION IN PRETERM INFANTS RECEIVING RECOMBINANT ERYTHROPOIETIN

Objective: To determine whether intravenously administered iron supple ments would improve the hematologic response to recombinant erythropoi etin in stable preterm infants. Methods: Forty-two preterm infants (<3 3 weeks' gestation, birth weight <1500 gm, hematocrit <38%) were treat ed with recombinant human erythropoietin (Eprex), 600 U/kg per week, a nd randomly assigned to receive either an oral preparation of ferrous lactate (elemental iron, 12 mg/kg per day) or an intravenous preparati on of iron sucrose (6 mg/kg per week). Results: Hematocrits, reticuloc yte counts, and transfusions were similar in the oral group (OG) and t he intravenous group (IVG), However, markedly higher serum ferritin co ncentrations were noted in the IVG (p < 0.001), and by completion of t he study the arithmetic mean values were 265 +/- 127 mu g/L versus 137 +/- 65 mu g/L in the IVG and the OG, respectively, The numbers of hyp ochromic erythrocytes increased in both groups during the study but we re significantly higher in the OG (p = 0.04), Mean daily weight gain i n the IVG (27 +/- 6.4 gm/day) was greater than in the OG (22.9 +/- 4.7 8 gm/day; p = 0.04). Conclusions: High doses of both orally administer ed iron and intravenously administered iron sucrose appear to supply s ufficient iron for erythropoiesis in stable infants, Storage iron may become depleted after oral supplementation. The intravenous preparatio n appears to be safe and maintains serum ferritin concentrations, and it may be indicated for patients with low ferritin levels and for thos e not established on enteral feedings.