Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants

In newborn infants, the number of red blood cells in the circulation decreases after birth. In infants born before term, this decrease is exaggerated by frequent withdrawal of blood, which may be necessary to monitor the infant's clinical condition. Therefore, infants born before term are likely to require transfusions of red blood cells. Low levels of erythropoietin (EPO), a substance in the blood that stimulates red blood cell production, in preterm infants provide a rationale for the use of EPO to prevent or treat anemia. EPO can be given "early" (before the infant reaches eight days of age) in order to prevent or decrease the use of red blood cell transfusions. More than 2200 infants born before term have been enrolled in 27 studies that used this approach. Early EPO treatment reduces the number of red blood cell transfusions and donor exposures following its use. However, the overall benefit of EPO may not be clinically important, as many of these infants had been exposed to red blood cell transfusions prior to entry into the trials. Treatment with early EPO did not have any important effects on mortality or common complications of preterm birth with the exception that EPO increased the risk for retinopathy of prematurity, a serious complication that may cause blindness in babies born before term. The addition of four new studies enrolling 145 infants did not change the conclusions. Based on our findings, EPO is not recommended for routine use in preterm infants.