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THE MAJORITY OF premature infants, especially very low birth weight (birth weight < 1500 g) infants, receive ≥ 1 red blood cell transfusion for anemia of prematurity during their first [...], OBJECTIVES. Erythropoietin is frequently administered to premature infants to stimulate erythropoiesis. The primary goal of erythropoietin therapy is to reduce transfusions, but the efficacy of erythropoietin has not been convincingly demonstrated in this regard. The aim of this trial was to investigate whether combined administration of vitamin [B.sub.12], folic acid, iron, and erythropoietin could decrease transfusion requirements in extremely low birth weight infants. PATIENTS AND METHODS. In a randomized, controlled trial, extremely low birth weight infants with a birth weight ≤ 800g and a gestational age ≤ 32 weeks were randomly assigned to a group receiving combination treatment or a control arm. RESULTS. The treatment increased levels of folate in red blood cells, vitamin [B.sub.12], ferritin, transferrin receptor levels in plasma, and reticulocyte counts. The proportion of infants requiring no transfusions was lower in the treatment group (38%) as compared with controls (5%). The treatment group and the need for mechanical ventilation were independent predictors of the number of transfusions in multiple regression analysis. Cox regression analysis indicated that combined therapy resulted in a 79% risk reduction for any transfusion. CONCLUSION. Combined treatment with erythropoietin, intravenous iron, folate, and vitamin [B.sub.12] during the first weeks reduces the need for transfusion in extremely low birth weight infants. Key Words folate, vitamin [B.sub.12], erythropoietin, iron, ELBW infant, transfusions Abbreviations RBC--red blood cell GA--gestational age ELBW--extremely low birth weight TFR--transferrin receptor CI--confidence interval IRF--immature reticulocyte fraction MCV--mean corpuscular volume ROP--retinopathy of prematurity

IMPROVED OXYGENATION AFTER birth results in systemic oxygen delivery that far exceeds oxygen consumption among newborns. Without hypoxic stimuli for erythropoietin production, (1) serum erythropoietin concentrations decrease and erythropoiesis declines [...], BACKGROUND. Premature infants, especially those with birth weights of METHODS. In a randomized, controlled trial, 64 premature infants (birth weight: 801-1300 g) receiving erythropoietin and iron supplementation were assigned randomly to receive either vitamin [B.sub.12] (3 µg/kg per day) and folate (100 µg/kg per day) (treatment group) or a lower dose of folate (60 µg/kg per day) (control group). RESULTS. During the 4-week observation period, vitamin [B.sub.12] and folate enhanced erythropoietin-induced erythropoiesis significantly, as indicated by a 10% increase in red blood cell counts, compared with folate alone. Hemoglobin and hematocrit levels remained stable in the treatment group, whereas they decreased in the control group. Vitamin [B.sub.12] levels in the treatment group increased over baseline and control values, whereas red blood cell folate levels were comparable between the groups. Subsequent analysis showed slight nonsignificant differences in baseline red blood cell count, hemoglobin level, hematocrit level, and mean corpuscular volume values, which must be addressed as a limitation. CONCLUSIONS. With the limitation of a slight imbalance in baseline data between the study groups, combined therapy with vitamin [B.sub.12], folate, erythropoietin, and orally and intravenously administered iron seemed more effective in stimulating erythropoiesis among premature infants, compared with erythropoietin, iron, and low-dose folate alone. Additional trials are necessary to confirm these data. www.pediatrics.org/cgi/doi/10.1542/ peds.2005-2475 doi:10.1542/peds.2005-2475 Key Words anemia of prematurity, erythropoietin, folic acid, vitamin [B.sub.12] Abbreviations RBC--red blood cell MCV--mean corpuscular volume TFR--transferrin receptor

Objective. To prospectively investigate the development of amplitude-integrated electroencephalographic (aEEG) activity during the first 2 weeks of life in neurologically normal and clinically stable preterm infants Patients and Methods. Infants with a GA of Results. Seventy-five infants (median GA: 27 weeks; range: 23-29 weeks) were eligible for inclusion in the reference group and had aEEG recordings during the first 2 weeks of life available. Analysis of aEEG background activity showed that with higher GA the relative amount of continuous activity increased while discontinuous patterns decreased. The number of bursts per hour decreased with increasing GA. Cyclical changes in aEEG background activity resembling early sleep-wake cycles were observed in all infants. Conclusions. Normal values for aEEG background activity were determined in preterm infants

BACKGR0UND. Premature infants, especially those with birth weights of <1500 g, often suffer from anemia of prematurity and associated problems. Erythropoietin therapy is a safe effective way to prevent and to treat anemia of prematurity. We hypothesized that combined administration of vitamin B12 and folate with erythropoietin and iron would enhance erythropoietin-induced erythropoiesis. METHODS. In a randomized, controlled trial, 64 premature infants (birth weight: 801-1300 g) receiving erythropoietin and iron supplementation were assigned randomly to receive either vitamin B12 (3 µg/kg per day) and folate (100 µg/kg per day) (treatment group) or a lower dose of folate (60 µg/kg per day) (control group). RESULTS. During the 4-week observation period, vitamin B12 and folate enhanced erythropoietin-induced erythropoiesis significantly, as indicated by a 10 % increase in red blood cell counts, compared with folate alone. Hemoglobin and hematocrit levels remained stable in the treatment group, whereas they decreased in the control group. Vitamin B12 levels in the treatment group increased over baseline and control values, whereas red blood cell folate levels were comparable between the groups. Subsequent analysis showed slight nonsignificant differences in baseline red blood cell count, hemoglobin level, hematocrit level, and mean corpuscular volume values, which must be addressed as a limitation. CONCLUSIONS. With the limitation of a slight imbalance in baseline data between the study groups, combined therapy with vitamin B12, folate, erythropoietin, and orally and intravenously administered iron seemed more effective in stimulating erythropoiesis among premature infants, compared with erythropoietin, iron, and low-dose folate alone. Additional trials are necessary to confirm these data. [ABSTRACT FROM AUTHOR]

Objective: To prospectively investigate the longitudinal changes of amplitude-integrated electroencephalographic (aEEG) activity in preterm infants <30 weeks gestational age (GA)., Methods: Infants (GA <30 weeks) without evidence of neurological abnormalities had weekly aEEG recordings performed. The relative duration of the three aEEG patterns (discontinuous low voltage, discontinuous high voltage and continuous) was determined and the influence of GA and postnatal age (PNA) on the occurrence of each pattern was assessed., Results: Ninety-eight infants (median GA 26 weeks; range 23-29 weeks) were studied. With higher GA (OR 1.68, 95% CI 1.33-2.13) and PNA (OR 1.91, 95% CI 1.53-2.38), the likelihood for the occurrence of continuous activity increased. The discontinuous low-voltage pattern was less likely to occur with increasing GA (OR 0.68, 95% CI 0.55-0.83) and PNA (OR 0.70, 95% CI 0.61-0.81)., Conclusion: Maturation of aEEG activity in preterm infants is influenced by both GA and PNA.