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Effect of recombinant human erythropoietin on transfusion needs in preterm infants
1Department of Neonatology, Singapore General Hospital, Singapore. gneycl@sgh.com.sg
Insights
Recombinant human erythropoietin (r-HuEPO) stimulates red blood cell production in very low birthweight (VLBW) infants. However, it only significantly reduces transfusion needs in VLBW infants weighing 800-999 grams at birth.
Area of Science:
- Neonatal Medicine
- Hematology
- Pharmacology
Background:
- Very low birthweight (VLBW) infants are at high risk for anemia and require frequent erythrocyte transfusions.
- Erythropoiesis-stimulating agents, such as recombinant human erythropoietin (r-HuEPO), are used to improve red blood cell production.
Purpose of the Study:
- To evaluate the efficacy, safety, and cost-effectiveness of r-HuEPO in reducing transfusion requirements in VLBW infants.
- To assess the impact of r-HuEPO across different birthweight subgroups.
Main Methods:
- A non-blind randomized controlled trial involving 100 VLBW infants (gestation < 33 weeks).
- Infants received either weekly subcutaneous r-HuEPO (750 U/kg) or no erythropoietin from day 5 to 40.
- Oral iron supplementation was provided to all infants. Transfusion needs were analyzed overall and by birthweight subgroups.
Main Results:
- r-HuEPO treatment led to higher reticulocyte counts and hematocrit levels compared to controls.
- No statistically significant difference in the mean number or volume of erythrocyte transfusions was observed for all VLBW infants.
- A significant reduction in transfusion needs was noted in infants weighing 800-999 g at birth (2.1 vs. 3.5 transfusions, P=0.04).
- The cost per patient for transfusion and r-HuEPO was comparable between groups (S$388 vs. S$438).
- Safety parameters including blood pressure, blood counts, and complications of prematurity showed no significant differences.
Conclusions:
- Weekly r-HuEPO administration effectively stimulates erythropoiesis in VLBW infants.
- The therapeutic benefit of reduced erythrocyte transfusions is specific to VLBW infants within the 800-999 g birthweight range.
- r-HuEPO demonstrates a favorable safety profile and comparable cost-effectiveness in this population.
Objective:
To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r-HuEPO) in reducing erythrocyte transfusion needs in very low birthweight (VLBW) infants.
Methods:
We conducted a non-blind randomized controlled trial and assigned 100 VLBW infants, less than 33 weeks gestation, to receive either r-HuEPO 750 U/kg per week subcutaneously from day 5 to day 40 or no erythropoietin (EPO). Infants received oral iron 3-6 mg/kg per day from day 10. Transfusion needs were analysed for all enrolled infants and in five weight subgroups: birthweight of less than 600 g, 600-799 g, 800-999 g, 1000-1199 g and infants more than 1200 g.
Results:
VLBW infants on r-HuEPO attained higher reticulocyte counts and haematocrit than control infants but the mean number of transfusions and volume of erythrocyte transfused per infant were not statistically different. Of infants 800-999 g at birth, the mean number of transfusions per infant was 2.1 compared with 3.5 transfusions per control infant (P = 0.04). Volume of erythrocytes transfused was 34.9 +/- 32.1 mL/kg in r-HuEPO-treated infants and 56.6 +/- 25.8 mL/kg in control infants (P = 0.03). The cost per patient for transfusion and EPO was S$388 for r-HuEPO recipient and S$438 for control infant. Blood pressure, neutrophil count, platelet count and complications of prematurity were not significantly different in both groups of VLBW infants.
Conclusion:
r-HuEPO at 750 U/kg per week stimulates erythropoiesis in VLBW infants but significantly reduces the need for erythrocyte transfusion only in infants weighing 800-999 g at birth.