EFFECT OF LOW AND MODERATE DOSES OF RECOMBINANT-HUMAN-ERYTHROPOIETIN ON THE HEMATOLOGICAL RESPONSE IN PREMATURE-INFANTS ON A HIGH-PROTEIN AND IRON INTAKE

There is no consensus regarding protein intake and the doses of recomb inant human erythropoietin (r-HuEpo) and iron in the treatment of anae mia of prematurity (AOP). This open, randomized study has compared the effectiveness of 50 IU r-HuEpo/kg with that of 100 IU/kg, both given subcutaneously thrice weekly. In addition, two different protein suppl ements have been compared; lyophilized human milk protein and a commer cial cow's milk product. Total protein intake was 3 g/kg per day. Dail y iron dose was 18-36 mg. ''Healthy'' preterm infants (n = 32, birth w eight: 800-1400 g, gestational age less than or equal to 31 weeks) wer e studied from age 3 to 8 weeks. The two protein regimens yielded no d ifferences in body growth, reticulocyte count or Hb concentration. In both r-HuEpo dose groups increased number of reticulocytes followed st art of treatment; higher levels were, however, found in the group rece iving 100 IU/kg. Mean Hb concentration plateaued at 12 g/dl for infant s receiving 100 IU/kg, at 11 g/dl in the 50 IU/kg group. Even though s erum levels of ferritin and transferrin saturation indicated no iron d eficiency, soluble transferrin receptor increased in both groups, more rapidly and to higher levels in the 100 IU/kg group. In addition, the number of infants having more than 8% hypochromic red cells increased in both groups. Conclusions Commercial cow's milk protein added to hu man milk was as good as human milk protein supplementation in supporti ng growth and erythropoiesis, Fifty IU/kg r-HuEpo thrice weekly during AOP stimulated erythropoiesis significantly,but less so than 100 IU/k g. Even when using high oral doses of iron to preterms receiving r-HuE po, our data suggested a certain degree of iron deficient erythropoies is.