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

The amount of circulating red blood cells (hematocrit) falls after birth in all infants. This is particularly true in preterm infants due to their poor response to anemia and to the amount of blood that is drawn for necessary testing. Low plasma 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/treat anemia. More than 1300 infants born preterm have been enrolled in 28 studies of late administration of EPO (at 8 days of age or later) to reduce the use of red blood cell transfusions and to prevent donor exposure. The guidelines for use of red blood cell transfusions varied among studies. EPO reduces the risk of receiving red blood transfusion following initiation of EPO treatment. However, the overall benefit of EPO is reduced as many of these infants had been exposed to donor blood prior to entry into the trials. Treatment with late EPO did not have any important effects on mortality or common complications of preterm birth, including retinopathy of prematurity. Future studies should focus on efforts to reduce the amount of blood withdrawn from sick newborns and the use of satellite packs (dividing one unit of donor blood into many smaller aliquots) to reduce donor exposure.