Effects of a combined therapy of erythropoietin, iron, folate, and vitamin [B.sub.12] on the transfusion requirements of extremely low birth weight infants

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