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Optimizing the approach to anemia in the preterm infant: is there a role for erythropoietin therapy?
1Department of Pediatrics, Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey, New Brunswick, USA.
Insights
Routine use of recombinant human erythropoietin (r-HuEPO) is unnecessary for most very low birth weight (VLBW) infants. Improved blood banking practices significantly reduce transfusion needs, making r-HuEPO cost-benefit analysis only supportive for infants under 750 gm.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Transfusion Medicine
Background:
- Very low birth weight (VLBW) infants often require blood transfusions.
- Recombinant human erythropoietin (r-HuEPO) is a potential treatment to reduce transfusion needs.
Purpose of the Study:
- To identify a specific subset of VLBW infants who could benefit from r-HuEPO treatment.
- To evaluate transfusion practices and their impact on VLBW infants.
Main Methods:
- Retrospective review of VLBW infant records (birth weight ≤ 1500 gm) admitted between January 1991 and December 1994.
- Analysis of transfusion frequency and donor exposures.
- Cost-benefit analysis of r-HuEPO use.
Main Results:
- VLBW infants received an average of 2.02 transfusions, fewer than previously reported.
- Infants weighing 1251-1500 gm received minimal transfusions.
- Improved blood bank protocols (assigned units held for 30 days) reduced donor exposures by 56-89%.
Conclusions:
- Current transfusion rates for VLBW infants are lower than historical data suggest.
- Optimized blood bank procedures minimize transfusion requirements.
- Routine r-HuEPO use is not cost-effective for most VLBW infants; its use is only supported for infants < 750 gm.
Objective:
To define a subset of very low birth weight (VLBW) infants who might benefit from recombinant human erythropoietin (r-HuEPO) treatment.
Study Design:
We reviewed the records for all VLBW (birth weight (BW) < or = 1500 gm) infants who were admitted to our nursery within the first 3 days of life between January 1991 and December 1994 and discharged alive.
Results:
These infants received an average of 2.02 transfusions, far fewer than the 7 to 11 previously reported for VLBW infants. Infants with a BW of 1251 to 1500 gm received very few transfusions. More than three quarters of transfused infants received a transfusion in the first 2 weeks of life before r-HuEPO would be expected to be effective. Assigning units to individual infants and holding the units for 14 days, a practice adopted in our blood bank in 1993, resulted in a 44% decrease in donor exposures in infants receiving more than one transfusion. Holding assigned units for 30 days, a practice our blood bank has now adopted, should result in 56% of all transfused infants having a single donor exposure and 89% having one or two donor exposures. Cost-benefit analysis only supports routine use of r-HuEPO in infants weighing less than 750 gm.
Conclusion:
VLBW infants receive far fewer transfusions than the number previously reported. Assigning units to individual patients and holding those units for 30 days, together with efforts to minimize the need for transfusions make routine use of r-HuEPO unnecessary.