Early treatment with erythropoietin β ameliorates anemia and reduces transfusion requirements in infants with birth weights below 1000 g

Objective: To investigate whether recombinant erythropoietin (rhEPO) reduces the need for transfusion in extremely low birth weight (ELBW) infants (birth weight 500-999 g) and to determine the optimal time for treatment. Methods: In a blinded multicenter trial, 219 ELBW infants were randomized on day 3 to one of 3 groups: early rhEPO group (rhEPO from the first week for 9 weeks, n = 74), late rhEPO group (rhEPO from the fourth week for 6 weeks, n = 74), or control group (no rhEPO, n = 71). All infants received enteral iron (3-9 mg/kg/day) from the first week. The rh EPO beta dose was 750 IU/kg/week. Success was defined as no transfusion and hematocrit levels never below 30%. Results: Success rate was 13% in the early rhEPO group, 11% in the late rhEPO group, and 4% in the control group (P = .026 for early rhEPO versus control group). Median transfusion volume was 0.4 versus 0.5 versus 0.7 mL/kg/day (P = .02) and median donor exposure was 1.0 versus 1.0 versus 2.0 (P = .05) in the early rhEPO group, the late rhEPO group, and the control group, respectively. Infection risk was not increased and weight gain was not delayed with rhEPO P. Conclusion: Early rhEPO a treatment effectively reduces the need for transfusion in ELBW infants. (J Pediatr 2002;141:8-15).