Elsevier

Clinics in Perinatology

Volume 27, Issue 3, 1 September 2000, Pages 681-696
Clinics in Perinatology

THE USE OF ERYTHROPOIETIN IN NEONATES

https://doi.org/10.1016/S0095-5108(05)70045-2Get rights and content

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PHYSIOLOGIC ANEMIA IN TERM AND PRETERM NEONATES

In term infants, improved oxygenation after birth results in systemic oxygen delivery that far exceeds oxygen consumption. Without a hypoxic stimulus for Epo production, serum Epo concentrations fall and erythropoiesis rapidly declines. The hemoglobin concentration decreases over the first 2 to 3 months of life as the infant gains weight, remains stable over the next several weeks as erythropoiesis is reinitiated, then rises in the fourth to sixth month of life in response to a greater Epo

CLINICAL STUDIES

Multiple clinical trials evaluating the use of Epo to prevent and treat anemia in preterm infants have been published in recent years and have reported a variety of results. Early pilot studies used doses that were effective in adults but were inadequate for neonates. These studies reported little or no effect of Epo in preterm infants. Following these initial reports, pharmacokinetic studies in newborn monkeys and sheep indicated that neonates have a larger volume of distribution and a more

EPO TREATMENT FOR OTHER NEONATAL ANEMIAS

Older term and preterm infants with hyporegenerative anemias seem to respond to Epo administration. One such group are infants with the anemia of bronchopulmonary dysplasia. This anemia was initially described by Alverson et al3 and subsequently characterized by Christensen and colleagues17 as a normocytic, normochromic, hyporegenerative anemia with marrow normoblast iron stains that are distinct from those observed in the anemia of chronic disorders and the anemia of prematurity. Patients with

PHARMACOKINETICS AND SIDE EFFECTS

As mentioned previously, studies in newborn monkeys and sheep demonstrate that neonates have a larger volume of distribution and a more rapid elimination of Epo,23, 75 necessitating the use of higher doses than required for adults. In preterm infants, the volume of distribution is threefold to fourfold greater than that seen in adults, whereas the clearance is three to four times greater (Table 4).59

Little is known about the efficacy of daily versus less frequent dosing schedules. Brown and

TRANSFUSION PRACTICES IN NEONATES

The clinical impact of Epo in preterm infants has had implications beyond testing a new therapy. Stricter transfusion criteria have been implemented as a result of these studies, resulting in safe and effective decreases in transfusions without an increase in the length of hospital stay or neonatal morbidities.10 Moreover, phlebotomy practices and blood banking techniques have been modified to meet the needs of VLBW infants in many of the clinical studies. Implementing and completing these

IS EPO BENEFICIAL?

The clinical use of Epo in preterm infants has clearly been shown to stimulate erythropoiesis, as evidenced by increased reticulocytosis and increased hematocrit. The question remains whether this stimulus is significant enough to offset the significant loss of blood that occurs in the first weeks of life on critically ill preterm infants. Numerous studies have demonstrated that the volume of phlebotomy losses, generally a measure of the severity of illness or prematurity, correlates directly

SUMMARY

Although much information has been accumulated about the clinical use of Epo in preterm infants, many questions remain unanswered. The evolution of clinical practice in the care of extremely ill, preterm infants continues to affect the number of transfusions required during hospitalization. Decreasing phlebotomy losses and instituting standardized transfusion guidelines have both been shown significantly to decrease the transfusion requirements of preterm infants. The administration of Epo

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  • Cited by (0)

    Address reprint requests to Robin K. Ohls, MD Department of Pediatrics, ACC-3W University of New Mexico Health Sciences Center Albuquerque, NM 87131–5311 e-mail: [email protected]

    Supported by grants HD-00988 and RR-00997 from the National Institutes of Health.

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