Document Detail


Recombinant erythropoietin compared with erythrocyte transfusion in the treatment of anemia of prematurity.
MedLine Citation:
PMID:  1941387     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To assess the risks and benefits of erythropoietin versus erythrocyte transfusion in the treatment of the anemia of prematurity, we randomly assigned 19 anemic preterm infants (birth weight 988 +/- 227 gm; gestational age 27.6 +/- 1.2 weeks; age 41 +/- 15 days; all values mean +/- SD) to receive either transfusion or subcutaneously administered erythropoietin (200 units/kg every other day for 10 doses). In the 10 erythropoietin recipients, corrected reticulocyte counts increased from 2% +/- 1% to 7% +/- 2% (p less than 0.001) and hematocrits increased from 27% +/- 2% to 30% +/- 4% (p less than 0.05). In the nine infants who underwent transfusion, reticulocyte counts did not increase, but hematocrits increased from 28% +/- 4% to 41% +/- 2% after initial transfusion (p less than 0.001) and had decreased to 34% +/- 5% by day 20. Signs attributed to anemia (tachycardia, apnea with bradycardia, and poor weight gain) declined in both the erythropoietin recipients and those who underwent transfusion. However, five of nine infants who underwent transfusion had symptoms within 10 to 14 days and were given further transfusions. Marrow aspiration performed after 7 to 10 days of treatment showed that infants receiving erythropoietin had greater percentages of erythropoietic precursors (p less than 0.01), greater concentrations of mature erythroid progenitors (p less than 0.001), and higher cycling rates of erythroid progenitors (p less than 0.001). The percentage of mature stored neutrophils in marrow was lower in the erythropoietin group than in the transfusion group, resulting in an inverse myeloid/erythroid ratio (0.5:1 vs 6.2:1; p less than 0.001). After 20 days, absolute blood neutrophil counts were lower in the erythropoietin recipients (1.8 +/- 0.9 x 10(3) cells/microliters) than in the infants who underwent transfusion (3.9 +/- 1.9 x 10(3) cells/microliters; p less than 0.05). Administration of erythropoietin thus stimulated erythropoiesis and relieved signs attributed to anemia; the significance of the relative neutropenia remains to be determined. We conclude that erythropoietin administration offers promise as an alternative to erythrocyte transfusion in neonates with symptomatic anemia of prematurity.
Authors:
R K Ohls; R D Christensen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  119     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  1991 Nov 
Date Detail:
Created Date:  1991-12-18     Completed Date:  1991-12-18     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  781-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Human Development, University of Utah School of Medicine, Salt Lake City.
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MeSH Terms
Descriptor/Qualifier:
Anemia, Neonatal / blood,  pathology,  therapy*
Blood Cells / pathology
Blood Component Transfusion*
Bone Marrow / pathology
Erythropoietin / blood,  therapeutic use*
Ferritins / blood
Hematocrit
Hematopoietic Stem Cells / pathology
Humans
Infant, Newborn
Infant, Premature / blood*
Infant, Premature, Diseases / blood,  pathology,  therapy*
Prospective Studies
Recombinant Proteins
Recurrence
Risk Factors
Grant Support
ID/Acronym/Agency:
HL-4495/HL/NHLBI NIH HHS; RR-00064/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Recombinant Proteins; 11096-26-7/Erythropoietin; 9007-73-2/Ferritins

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