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

The number of red blood cells falls after birth in preterm infants due to the natural breakdown of erythrocytes and blood letting. 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. A total of 262 infants born preterm have been enrolled in two studies of early vs. late administration of EPO to prevent blood transfusions. There were no demonstrable benefits of early vs. late administration of EPO with regards to reduction in the use of red blood cell transfusions, number of transfusions, the amount of red cells transfused or number of donor exposures per infant. However, the use of early EPO compared to late EPO administration increases the risk of retinopathy of prematurity, a serious complication in babies born before term. Currently, there is lack of evidence that either treatment confers any substantial benefits with regard to any donor blood exposure, as many infants enrolled in both studies were exposed to donor blood prior to study entry, and early EPO increases the risk of retinopathy of prematurity. Neither early nor late administration of EPO is recommended.