Effects of red cell transfusion on cardiac output and blood flow velocities in cerebral and gastrointestinal arteries in premature infants.

Anaemia may increase the risk of tissue hypoxia in preterm infants. The effect of transfusion on circulation was studied in 33 preterm infants with a mean (SD) gestational age of 29 (5) weeks (range 26-34), birth weight 1153 (390) g (range 520-1840), and postnatal age of 48 (21) days (range 19-100). Packed cell volume, blood viscosity (capillary viscometer), cardiac output, and cerebral blood flow velocities in the internal carotid artery, anterior cerebral artery, and coeliac trunk (Doppler ultrasound) were determined before and after transfusion of 10 ml/kg of packed red blood cells. Transfusion increased packed cell volume from a mean (SD) 0.27 (0.45) to 0.37 (0.48). Mean arterial blood pressure did not change while heart rate decreased significantly from 161 (14) l/min to 149 (12). Cardiac output decreased from 367 (93) ml/kg/min to 311 (74) due to decrease in stroke volume from 2.28 (0.57) ml/kg to 2.14 (0.46) and in heart rate. There was a significant increase in systemic red cell transport (cardiac output times packed cell volume) by 17%, systemic flow resistance (blood pressure to cardiac output ratio) by 23%, and blood viscosity by 33%. Vascular hindrance (flow resistance to blood viscosity ratio) did not change significantly, thereby suggesting that neither vasoconstriction nor vasodilation occurred with transfusion. After transfusion blood flow velocities decreased significantly in the anterior cerebral artery by 23%, in the internal carotid artery by 8%, and in the coeliac trunk by 12%. Red cell transport estimated as products of blood flow velocities times packed cell volume increased significantly by 25% in the internal carotid artery and by 21% in the coeliac trunk. These results indicate that red cell transfusion improved systemic oxygen transport as well as oxygen transport in the internal carotid artery and coeliac trunk.     

Strict guideline reduces the need for RBC transfusions in premature infants

The aim of this study was to verify if the adoption of a strict guideline would reduce the need for red blood cell transfusions in the first 28 days of life in very low birth weight preterm infants. Retrospective study of two cohorts of very low birth weight infants transfused according to neonatologist decision (Period 1) or according to a strict guideline for erythrocytes transfusion (Period 2). Clinical and hematological data of 80 premature infants transfused in both periods of the study were obtained by chart review. During the first 28 days of life, 45 (62.5%) of 72 premature infants born in the Period 1, and 44 (55.7%) of 79 newborns born in Period 2 received at least one erythrocyte transfusion; p = 0.40. Among patients transfused, the median number of transfusions was four per infant transfused (range: 1-13; mean: 4.6 +/- 3.2) in Period 1 and 3 (range: 1-18; mean: 4.0 +/- 3.5) in Period 2; p = 0.26. The median volume of erythrocytes administered per infant transfused in Period 1 was 40 ml kg(-1) (range: 10-170; mean: 48.8 +/- 38.3) and in Period 2 was 30 ml kg(-1) (range: 10-225; mean: 43.4 +/- 40.4), p = 0.41. Multiple linear regression analysis, after adjusting for birth weight, clinical risk index for babies, blood loss and days of ventilation, showed that the adoption of the strict guideline reduced the volume of erythrocytes transfused in 15.91 ml kg(-1) per infant transfused (95% CI: -24.69-7.14) p < 0.001. The adoption of a strict guideline reduced the need for red blood cells transfusions in very low birth weight infants.     

Effects of red cell transfusion on pulmonary blood flow and right ventricular systolic time intervals in neonates

Blood transfusion increases blood volume and blood viscosity of the neonate. Since both volume expansion and increase in blood viscosity may be associated with increased pulmonary artery pressure, we studied effects of transfusion (10 ml of red blood cells per kilogramme of body weight) on right ventricular output and right systolic time intervals by means of pulsed-Doppler echocardiography in 38 preterm infants with a mean (SD) gestational age of 28 (5) weeks (range 25–34), birth weight 1060 (395) g (range 480–1910), actual body weight 1875 (450) g (range 820–2790) and postnatal age of 44 (23) days (range 17–105). After transfusion, packed cell volume and haemoglobin increased significantly from 0.26 (0.044) to 0.38 (0.046), and from 8.2 (1.6) g/l to 12.8 (1.9), respectively. Blood viscosity increased from 1.78 (0.3) mPa to 2.68 (0.4) by 33%. Right ventricular output decreased significantly from 320 (57) ml/kg/min to 290 (70) due to decrease in heart rate by 7%. Blood pressure and right ventricular stroke volume did not change. There was a significant increase in pulmonary red cell transport (right ventricular output times packed cell volume) of 21%. Right ventricular pre-ejection period (RPEP), right time peak velocity (RTPV), right ventricular ejection time (RVET), and ratios of RTPV/RVET_(c), RPEP:RVET did not change after transfusion. Conclusion These results suggest that neither pulmonary artery pressure nor right ventricular function changed as a result of transfusion in spite of rising blood volume and blood viscosity. Received: 19 October 1996 / Accepted: 23 December 1996     

A comparison of high and standard blood transfusion volumes in premature infants

We compared high volume (20 ml/kg) with standard volume (15 ml/kg) packed red blood cell (PRBC) transfusions in a randomized trial. Ten high volume babies received a mean of 2.8 transfusions, while 10 standard volume babies received a mean of 3.4 (p=0.58). No adverse events were attributed to the use of the high volume transfusions. CONCLUSION: Higher transfusion volumes appear to be well tolerated. The data can be used in the planning of larger controlled trials in VLBW infants.     

PLASMA AND BLOOD VOLUMES IN SEVERELY MALNOURISHED INFANTS

ABSTRACT. Zoumboulakis, D., Anagnostakis, D., Kiossoglou, K., Agathopoulos, A. and Tsenghi, C. (Department of Paediatrics, Athens University, Athens, Greece). Plasma and blood volumes in severely malnourished infants. Acta Wediatr Scand, 63: 507, 1974. —This study was carried out in order to gain some insight into the plasma and blood volume fluctuations in severely malnourished infants. By means of an isotope dilution technique and microhaematocrit measurements, plasma and blood volumes were studied in 18 severely malnourished infants, aged 5 to 20 months and in 5 healthy controls, aged 3 to 20 months. Both plasma and blood volumes were found to be considerably higher in the malnourished infants (79.22±14.5 ml/kg and 119±17.8 ml/kg, respectively) than those in the controls (51.6±6.8 and 76.4±7.7 mg/kg, respectively. The differences in both instances were statistically highly significant. When, however, plasma and blood volumes were expressed not by means of the actual body weight but per kg of the expected body weight for height, there were no significant differences between malnourished (50.6±9.4 ml/kg and 76.1±12.4 ml/kg respectively), and healthy infants (51.6±6.8 ml/kg and 76.4±7.7 ml/kg respectively). These results suggest that the absolute intravascular fluid volume, which plays an important role in maintaining normal homeostasis, is unchanged in malnutrition.     

Effect of blood transfusions on oxidative stress in preterm infants

OBJECTIVE: To confirm the increase in non-transferrin bound iron (NTBI) after packed red cell (PRC) transfusion and to evaluate the association with increased oxidative stress in preterm infants. METHOD: Twenty healthy preterm infants (gestational age 28.2 (2.2) weeks; birth weight 1047 (230) g), who required blood transfusion for anaemia of prematurity were prospectively studied. Serum concentrations of NTBI, total hydroperoxides (TH), and protein SH groups, and plasma total radical trapping antioxidant capability (TAC) were measured within three hours before and after PRC transfusion. The infants were transfused with 38.6 (23) ml PRCs over 5.8 (1.0) hours, at a mean age of 43.3 (25.1) days. RESULTS: After PRC transfusion, haemoglobin concentration increased from 9.2 (1.1) to 14.6 (1.5) g/l. Mean plasma NTBI concentration after transfusion was significantly higher (0.43 (0.45) v 2.03 (1.31) micromol/l; p = 0.001), while plasma concentrations of TH (212.3 (42.2) v 214.7 (66.3) Carr units/l) and protein SH groups (317.5 (38.8) v 353.8 (57.4) micromol/), and TAC (256.3 (36.1) v 267.1 (42.4) micromol HClO/ml) remained unchanged. CONCLUSION: For three hours after PRC transfusion, plasma NTBI is significantly increased in preterm infants, but this is not associated with significant changes in oxidative stress.     

Blood sampling in very low birth weight infants receiving different levels of intensive care

Sixty very low birth weight infants (birth weight 560–1450g) were studied during the first 28 days of life. The infants were classified as group A (n=19 infants who never required ventilator support), group B (n=20 infants mechanically ventilated for minor respiratory problems), and group C (n=21 infants ventilated for respiratory distress syndrome). Diagnostic blood sampling was measured, infants were checked for clinical symptoms and laboratory signs of anaemia 24 h before and after the transfusion of packed red cells. A total of 7998 punctures (average: 4.8 per infant per day) were performed, the mean blood loss due to diagnostic sampling was 50.3 ml/kg per 28 days (range 7–142) for all infants. A high correlation (r _s=+0.91) was found between the blood volumes sampled and transfused. In group A, the mean blood loss was 24 ml/kg, and a total of 29 blood transfusions were administered. The most frequent symptoms of anaemia were poor weight gain and apnoeic spells. In group B, the mean blood loss was 60 ml/kg and a total of 97 blood transfusions were administered. In group C, the mean blood loss was 67 ml/kg and a total of 116 blood transfusions were administered. In both groups B and C, poor weight gain, pallor and distended abdomen were the most frequent symtoms of anaemia. Following the blood transfusion, haematocrit rose and blood pressure remained unchanged. The symptoms that responded most favourably to the blood transfusion were: poor weight gain, oxygen requirement, and distended abdomen. The results emphasize the need for miniaturizing laboratory techniques and monitoring blood sampling.Abbreviations RDS respiratory distress syndrome - Hb haemoglobin     

The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates

This study was done to compare postnatal alterations in blood viscosity (capillary viscometer) and its determinants: hematocrit, plasma viscosity (capillary viscometer), red cell aggregation (Myrenne aggregometer) and red cell deformability (rheoscope) in the first five days of postnatal life in full-term neonates with early (< 10 s) and late (3 min) cord-clamping. The fetal blood volume of the placenta ("residual placental blood volume") decreased from 52 +/- 8 ml/kg of neonatal body weight after early cord-clamping to 15 +/- 4 ml/kg after later cord-clamping. Neonatal blood volume, calculated as the difference between an assumed total feto-placental blood volume of 115 ml/kg and the measured fetal blood volume of the placenta, was 50% higher in the late cord-clamped infants than in the early cord-clamped infants. Both groups showed similar viscosity, hematocrit and other rheological parameters in cord blood. In the infants with early cord-clamping, the hematocrit decreased from 0.48 +/- 0.04 l/l at birth to 0.43 +/- 0.6 l/l after 24 h (p < 0.05). Whole blood viscosity did not change significantly with age. After late cord-clamping, the hematocrit rose from 0.50 +/- 0.04% at birth to 0.63 +/- 0.05 l/l at 2 h of age (p < 0.005) and dropped to 0.59 +/- 0.5 l/l (p < 0.05) at 24 h. Blood viscosity increased by 40% (p < 0.001) within the first 2 h, but did not change significantly during the following five days. In both groups, plasma viscosity and red cell aggregation increased significantly (p < 0.05) on day 5 due to significant increases in total plasma protein and fibrinogen concentrations (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

超低出生体重儿红细胞输注的临床分析

探讨超低出生体重(ELBW)儿减少红细胞输注的可能性。方法对1989～1997年9年间256 例超低出生体重儿的红细胞输注进行临床分析。在此期间红细胞输注指征进行了3次制订,对检验样本的采 血量进行了严格的控制,部分病例应用了重组人促红细胞生成素治疗。结果1994年以后有1/4的ELBW儿 不需要输注红细胞,1989～1997年平均输血次数由7次降至2.7次(P＜0.01)。按出生体重累计红细胞输注 量由163.5mL/kg降至69.2mL/kg(P＜0.01),接受供血者人数由6.3人降至1.5人(P＜0.01)。红细胞输注 前的平均红细胞压积比,机械通气者由0.43降至0.34、自主呼吸者由0.41降至0.31。ELBW儿更加不成熟,平 均胎龄由27.4周减至26.0周,平均出生体重由833g降至741g。存活率仍达78％,住院时间没有延长,严重并 发症如视网膜病、动脉导管未闭、脑室出血的发生率没有增加。结论制订严格的红细胞输注指征有助于减少 输血次数和接受供血者人数,且患儿临床耐受良好。     

Haemodynamic effects of erythrocyte transfusion in preterm infants

The aim of the study was to assess the short-term cardiorespiratory effects of a standard red cell transfusion in very low birth weight (<1500 g) infants undergoing intensive care. A total of 37 infants (birth weight 920±230 g, gestational age 27.8±2.1 weeks, age at study 6.1±3.9 days) with indwelling arterial lines were studied when 10 ml/kg of packed donor red cells were transfused based on clinical judgment. Infants with patent ductus arteriosus and/or inotropic treatment were excluded from the study. Oxygen saturation, left ventricular output, stroke volume, systolic, diastolic and mean arterial pressure, heart rate, and capillary refill time were assessed immediately prior to the transfusion and within an hour after the transfusion was completed. Capillary refill time after the transfusion was significantly shorter than prior to the transfusion (2.1±0.9 versus 2.4±1.0 s, P =0.033). Left ventricular output, stroke volume and arterial pressures remained unaltered. Oxygen saturation after the transfusion was lower than before the transfusion (94.0±3.8 versus 95.3±2.5%, P =0.014) despite unaltered oxygen supply. Conclusion: the data suggest that although a red cell transfusion of 10 ml/kg may marginally improve peripheral perfusion, it does not influence cardiac output and arterial blood pressure in normotensive preterm infants. It may, however, cause a transient decrease in oxygen saturation.Abbreviations CRT capillary refill time - HR heart rate - LVO left ventricular output - PDA patent ductus arteriosus - SV stroke volume     

Posttransfusion equilibration of hematocrit in hemodynamically stable neonates.

OBJECTIVE: To determine whether hematocrit obtained 15 mins after blood transfusion in hemodynamically stable neonates is significantly different from that obtained after 6 hrs. We hypothesized that the hematocrit stabilizes within the first 15 mins that follow a 3-hr blood transfusion in preterm infants. DESIGN: We prospectively studied 24 consecutive infants who received blood transfusion. Hematocrit was measured immediately before the transfusion and 15 mins and 6 hrs after the transfusion of 10 mL/kg body weight of sedimented red blood cells administered over 3 hrs. Hematocrit was measured by centrifugation of a capillary. RESULTS: There was a significant increase in hematocrit from pretransfusion values both at 15 mins and 6 hrs. The increase in hematocrit from the pretransfusion value was identical (11%) at both 15 mins and 6 hrs. CONCLUSION: The hematocrit obtained 15 mins after the end of a 3-hr blood transfusion in hemodynamically stable, anemic infants is indistinguishable from that obtained after 6 hrs in the same infants. Thus, if the increase of hematocrit is deemed insufficient at 15 mins after the transfusion, it is possible to complete the transfusion without exposing the patient to an additional donor.     

Red blood cell transfusion for infants with single-ventricle physiology

The purpose of this study was to assess how red blood cell (RBC) transfusions impact hemodynamic parameters in infants with single-ventricle lesions. This was a retrospective chart review. The setting was a pediatric cardiac intensive care unit at a tertiary care children??s hospital. Fifty-nine patients <1?year of age with single-ventricle physiology who received a blood transfusion between December 2007 and April 2009 were analyzed. They received a total of 183 transfusions. Exclusion criteria included transfusions given within 72?h of cardiac surgery or transfusions given to patients with active bleeding. There were no interventions. The study population was divided into terciles based on pretransfusion hemoglobin (Hgb) concentration. The pretransfusion Hgb concentration in group A was 7.8 to 12.3?gm/dl, in group B was 12.4 to 13.2 gm/dl, and in group C was 13.3 to 15.7?gm/dl. Heart rate, blood pressure, arterial saturation, and cerebral near-infrared spectroscopy (cNIRS) values before transfusion, as well as at 1, 2, 4, 8, and 12?h after transfusion, were collected. There was significant improvement in diastolic blood pressure, arterial saturation, and cNIRS in group A after 12?h. Transfusions given in group B also resulted in improvement in diastolic blood pressure and arterial saturation, with less robust response of cNIRS. In group C, only arterial saturation values increased significantly. RBC transfusions can improve hemodynamics and markers of oxygen delivery in infants with single-ventricle physiology, but further studies are needed to determine an optimal Hgb level in this population. Interventions to increase Hgb above this level may be of limited benefit.     

Transfusion volume in infants with very low birth weight: a randomized trial of 10 versus 20 ml/kg

BACKGROUND: Although preterm infants often require transfusions of red blood cells for anemia of prematurity, the optimal volume of blood to be transfused has not been established. OBSERVATIONS: Infants with birth weights between 500 and 1,500 g were randomly assigned to receive 10 or 20 mL/kg red blood cells. Infants with transfusions of 20 mL/kg had a greater hemoglobin (14.2 +/- 1.9 vs. 12.0 +/- 1.9 g/dL, P = 0. 003) and hematocrit (41.2 +/- 5.9 vs. 32.3 +/- 7.1%, P = 0.001) levels after transfusion compared with those who received transfusions of 10 mL/kg. There were no measured differences in pulmonary function in either group after transfusion. CONCLUSIONS: Transfusion with 20 mL/kg red blood cells produces a significantly greater increase in hemoglobin and hematocrit levels than does a transfusion with 10 mL/kg, without any detrimental effects on pulmonary function.     

Changes in Plasma Concentrations of Atrial Natriuretic Peptide during Exchange Transfusion in Premature Infants

ABSTRACT. Plasma concentrations of atrial natriuretic peptide (ANP) and hemodynamic parameters were investigated in five premature infants undergoing exchange transfusion. Baseline values of ANP were 51.7 ± 21.2 fmol/ml. Volume depletion by withdrawal of 10 ml blood did not cause changes in systolic blood pressure (79.4 ± 4.3 vs. 71.4 ± 5.6 mmHg) and heart rate (115 ± 5.2 vs. 115 ± 2.4 b/min). ANP levels in plasma remained unaltered (53.4 ± 24.9 fmol/ml). Replacement of 10 ml blood increased central venous pressure by 33% and ANP concentration in the plasma by nearly 30%, while heart rate and blood pressure remained unchanged. Our data indicate that the heart of the premature infant responded to acute blood replacement with increased ANP-release, while blood removal appeared not to influence hormone regulation.     

Effect of wheat grass tablets on the frequency of blood transfusions in Thalassemia Major

Forty patients of Thalassemia Major children were treated with wheat grass tablets (WGT). The mean hemoglobin in the pre WGT was 8.54 +/− 0.33 g% whereas in WGT period was 9.13 +/− 0.14 g% (p < 0.001). The mean blood transfused as packed cells in pre WGT period was 326.82 +/− 74.10ml/kg/year whereas during WGT period it was 256.39 +/− 45.47 ml/kg/year. The percentage difference in the amount of packed cells transfused in pre WGT and WGT period was 18.02 +/− 22.96 (p < 0.001). The decrease in the blood transfusion requirements was by 25% or more in 20 (60.6%) cases. The mean interval between the consecutive blood transfusions in Pre WGT period was 18.78 +− 4.48 days whereas in WGT period was 24.16 +− 4.78 days (p < 0.001). Wheat grass has the potential to increase the Hb levels, increase the interval between blood transfusions and decrease the amount of total blood transfused in Thalassemia Major patients.     

Hepatic iron storage in very low birthweight infants after multiple blood transfusions

OBJECTIVE: To investigate the effect of multiple blood transfusions on hepatic iron storage in preterm, very low birthweight (VLBW) infants. METHODS: Seventeen VLBW infants who died within the first six months of life and underwent postmortem examination were studied. Serum ferritin, iron, and total iron binding capacity were measured within the week before the infants' death. Liver iron concentration was quantitatively determined by atomic absorption spectrophotometry and semiquantitatively assessed by histochemical liver iron grading. The clinical characteristics and the iron results were compared between infants receiving < 100 ml of blood (group A) and those receiving >/= 100 ml (group B). Spearman's correlation coefficient was used to evaluate the relation between the volume of blood transfused and serum/liver iron concentrations. Statistically significant variables associated with liver iron concentration were further subjected to multivariate stepwise regression analysis. RESULTS: Infants in group B had significantly higher serum iron (p < 0.01), serum ferritin (p < 0.01), and liver iron concentration (p < 0.01) than those in group A. The total and net volume of blood transfused were significantly associated with liver iron concentration (p < 0.001, r = 0.86; p < 0.001, r = 0.71 respectively), semiquantitative histochemical liver iron grading (p < 0.001, r = 0.80; p < 0.005, r = 0.71 respectively), and serum ferritin (p < 0.001, r = 0.84; p < 0.01, r = 0.69 respectively). In addition, both liver iron concentration and liver iron grading were found to be significantly associated with serum ferritin (p < 0.001, r = 0.76; p < 0.005, r = 0.68 respectively). Multivariate stepwise regression analysis indicated that the (log) liver iron concentration was significantly associated with the (log) volume of blood transfusion (p < 0.001; regression coefficient 0.39, SE 0.09), after adjustment for gestational age (R(2) = 0.84). CONCLUSIONS: This study showed a significant positive relation between the volume of blood transfused and the liver iron concentration in preterm VLBW infants. Although the transfusional blood volume correlated closely with the amount of iron deposited in hepatic tissues, clinical manifestations of iron overload were not observed. Carers should be aware of this potential harmful effect before prescribing blood or routine iron supplement to vulnerable preterm infants.     

The effect of blood transfusion on oxygenation in premature ventilated neonates

The effect of blood transfusion to maintain a preset packed cell volume (PCV) level in preterm ventilated infants has been investigated. Fifty infants, median gestational age 26 (range 23–33) weeks and postnatal age 4 (1–29) days, transfused a median of 15 ml/kg of blood in response to a PCV ≤ 40% were retrospectively identified and their medical records reviewed to determine the change in PCV and haemoglobin resulting from the transfusions. In addition, their mean airway pressure (MAP) was noted and, as an index of oxygenation, their oxygenation index (OI), alveolar/arterial oxygen gradient (AaDO₂) and arterial/alveolar (a/A) ratio calculated 12 h, 6 h and immediately prior to the transfusion and immediately post, 12, 18 and 24 h after the transfusion. The transfusion improved the PCV and haemoglobin (P < 0.0001). No significant changes in MAP or level of oxygenation were experienced in the 12 h prior to the transfusion. Post transfusion, despite no significant change in MAP, the AaDO₂ OI and a/A ratios compared to immediately prior to the transfusion were significantly better at 12, 18 and 24 h. Conclusion It is useful to transfuse ventilated preterm infants to maintain their PCV above a preset level. Received: 8 March 1996 / Accepted: 1 July 1996     

Effects of positive and negative pressure ventilation on cerebral blood volume of newborn infants

The effects of intermittent positive airway and continuous negative extrathoracic pressure ventilation on cerebral blood volume in preterm infants were studied using near infrared spectroscopy. In 12 infants continuous negative extrathoracic pressure caused a median decrease in cerebral blood volume of 0.14ml/100ml brain (95% confidence intervals (CI) 0.035–0.280) compared with no respiratory support. Oxygenated and deoxygenated haemoglobin also decreased, implying increased venous drainage as the main effect. In 17 infants intermittent positive pressure ventilation also caused a median reduction in cerebral blood volume of 0.06 ml/100 ml brain (95% CI 0.010–0.115) compared with endotracheal positive airway pressure. Deoxygenated haemoglobin increased by 0.07 ml/100 ml brain (95% CI 0.010–0.100) while oxygenated haemoglobin decreased by O.lOml/lOOml brain (95% CI 0.005–0.175). The increase in deoxygenated haemoglobin implies decreased venous drainage and the decrease in oxygenated haemoglobin implies that other factors may also be significant. Heart rate, blood pressure and oxygen saturation were monitored continuously and remained stable.     

Stepping up versus standard doses of erythropoietin in preterm infants: a randomized controlled trial

In this study, it is hypothesized that a planned increase in the dose of recombinant human erythropoietin (rh-EPO) can prevent transfusion in very low birth weight infants. Two different regimens of rh-EPO were administrated, one consisting in increasing dosage up to 5000 U/kg/wk, according to the individual reticulocytes response, and the second in a standard therapy of 1250 U/kg/wk. Fifty-one infants participated. Despite a significant higher reticulocytosis, the study was prematurely terminated due to the results of an interim analysis showing that transfusion was not avoided by increasing the rh-EPO. No significant differences were found between the two regimens concerning transfusion rate, volume transfused, gain in weight, and adverse effects. Progressive titration of rh-EPO to improve the biological response does not leave premature infants free of transfusion.     

Effect of recombinant human erythropoietin on transfusion needs in preterm infants

OBJECTIVE: To study the efficacy, safety and cost effectiveness of recombinant human erythropoietin (r-HuEPO) in reducing erythrocyte transfusion needs in very low birthweight (VLBW) infants. METHODS: We conducted a non-blind randomized controlled trial and assigned 100 VLBW infants, less than 33 weeks gestation, to receive either r-HuEPO 750 U/kg per week subcutaneously from day 5 to day 40 or no erythropoietin (EPO). Infants received oral iron 3-6 mg/kg per day from day 10. Transfusion needs were analysed for all enrolled infants and in five weight subgroups: birthweight of less than 600 g, 600-799 g, 800-999 g, 1000-1199 g and infants more than 1200 g. RESULTS: VLBW infants on r-HuEPO attained higher reticulocyte counts and haematocrit than control infants but the mean number of transfusions and volume of erythrocyte transfused per infant were not statistically different. Of infants 800-999 g at birth, the mean number of transfusions per infant was 2.1 compared with 3.5 transfusions per control infant (P = 0.04). Volume of erythrocytes transfused was 34.9 +/- 32.1 mL/kg in r-HuEPO-treated infants and 56.6 +/- 25.8 mL/kg in control infants (P = 0.03). The cost per patient for transfusion and EPO was S$388 for r-HuEPO recipient and S$438 for control infant. Blood pressure, neutrophil count, platelet count and complications of prematurity were not significantly different in both groups of VLBW infants. CONCLUSION: r-HuEPO at 750 U/kg per week stimulates erythropoiesis in VLBW infants but significantly reduces the need for erythrocyte transfusion only in infants weighing 800-999 g at birth.