Early erythropoiesis-stimulating agents in preterm or low birth weight infants

Ohlsson, Arne; Aher, Sanjay M

doi:10.1002/14651858.cd004863.pub6

Cited by 40 publications

(40 citation statements)

References 109 publications

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“…These infants often receive erythropoietin in an effort to reduce the need for blood transfusions. 28 Given that these factors were independently associated, another contributor may be the age-related changes in the developing hemostatic system of these infants. 8,29 Qualitative and quantitative changes occurring from fetal life through the neonatal period affect the ratios of fetal and adult forms of many coagulation proteins-which may affect the ability of the hemostatic system to avoid pathologic bleeding or thrombosis under significant physiologic stress.…”

Section: Discussionmentioning

confidence: 99%

Thrombosis in infants in the neonatal intensive care unit: Analysis of a large national database

Robinson

Achey

Nag

et al. 2021

Journal of Thrombosis and Haemostasis

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Background Thrombosis in the neonatal population is rare, but increasing. Its incidence and management are not well understood. Objectives To investigate the incidence, associated factors, and management of thrombosis in the neonatal intensive care unit (NICU) population. Patients/Methods We performed a retrospective cohort study of infants admitted to a Pediatrix Medical Group‐affiliated NICU from 1997 through 2015. We determined the prevalence of venous and arterial thrombosis, and assessed demographic characteristics and known risk factors. Categorical variables were compared with the Pearson χ2 test and continuous variables with Wilcoxon rank‐sum tests. Stepwise logistic regression was used to identify associated factors. The primary outcome was incidence of thrombosis. Secondary analyses investigated correlations between clinical and demographic characteristics and thrombosis. Results Among 1 158 755 infants, we identified 2367 (0.20%) diagnosed with thrombosis. In a multivariable regression analysis, prematurity, male sex, congenital heart disease, sepsis, ventilator support, vasopressor receipt, central venous catheter, invasive procedures, and receipt of erythropoietin were associated with increased risk of thrombosis, while Black race and Hispanic ethnicity were associated with reduced risk. The majority of infants diagnosed with thrombosis (73%) received no anticoagulation, but anticoagulant use in infants with thrombosis was higher than those without (27% versus 0.2%, P < .001). Thrombosis in infants was associated with higher mortality (11% versus 2%, P < .001) and longer hospital stays (57 days, [interquartile range (IQR) 28‐‐100] versus 10 days, [IQR 6‐‐22], P < .001). Conclusions In the largest national study to date, we found that thrombosis in NICU patients is associated with prematurity, low birth weight, sepsis, and invasive procedures.

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Section: Discussionmentioning

confidence: 99%

Thrombosis in infants in the neonatal intensive care unit: Analysis of a large national database

Robinson

Achey

Nag

et al. 2021

Journal of Thrombosis and Haemostasis

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“…Endogenous erythropoietin is essential for the production of erythrocytes. Several studies have reported substantial neuroprotective properties of erythropoietin, functioning in the brain as both an important growth factor and a neuroprotective agent (65)(66)(67)(68). RBC transfusions during NICU admission may result in less endogenous erythropoietin production.…”

Section: Anemia Rbc Transfusions and Neurodevelopmental Outcomementioning

confidence: 99%

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

et al. 2021

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Background: Anemia remains a common comorbidity of preterm infants in the neonatal intensive care unit (NICU). Left untreated, severe anemia may adversely affect organ function due to inadequate oxygen supply to meet oxygen requirements, resulting in hypoxic tissue injury, including cerebral tissue. To prevent hypoxic tissue injury, anemia is generally treated with packed red blood cell (RBC) transfusions. Previously published data raise concerns about the impact of anemia on cerebral oxygen delivery and, therefore, on neurodevelopmental outcome (NDO).Objective: To provide a systematic overview of the impact of anemia and RBC transfusions during NICU admission on cerebral oxygenation, measured using near-infrared spectroscopy (NIRS), brain injury and development, and NDO in preterm infants.Data Sources: PubMed, Embase, reference lists.Study Selection: We conducted 3 different searches for English literature between 2000 and 2020; 1 for anemia, RBC transfusions, and cerebral oxygenation, 1 for anemia, RBC transfusions, and brain injury and development, and 1 for anemia, RBC transfusions, and NDO.Data Extraction: Two authors independently screened sources and extracted data. Quality of case-control studies or cohort studies, and RCTs was assessed using either the Newcastle-Ottawa Quality Assessment Scale or the Van Tulder Scale, respectively.Results: Anemia results in decreased oxygen-carrying capacity, worsening the burden of cerebral hypoxia in preterm infants. RBC transfusions increase cerebral oxygenation. Improved brain development may be supported by avoidance of cerebral hypoxia, although restrictive RBC transfusion strategies were associated with better long-term neurodevelopmental outcomes.Conclusions: This review demonstrated that anemia and RBC transfusions were associated with cerebral oxygenation, brain injury and development and NDO in preterm infants. Individualized care regarding RBC transfusions during NICU admission, with attention to cerebral tissue oxygen saturation, seems reasonable and needs further investigation to improve both short-term effects and long-term neurodevelopment of preterm infants.

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“…Moreover, significant negative associations between BSID-III scores, transfusion volume, and donor exposure were observed in the placebo group, but not in the rhEPO group (14). Since an early start of rhEPO therapy significantly reduced the number of RBC transfusions, as shown in the updated Cochrane Review and in the recent PENUT trial (15,16), rhEPO may still reclaim its value in the patient blood management of very preterm infants.…”

Section: Discussionmentioning

confidence: 96%

Prophylactic Erythropoietin for Neuroprotection in Very Preterm Infants: A Meta-Analysis Update

et al. 2021

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Early erythropoiesis-stimulating agents in preterm or low birth weight infants

Cited by 40 publications

References 109 publications

Thrombosis in infants in the neonatal intensive care unit: Analysis of a large national database

Thrombosis in infants in the neonatal intensive care unit: Analysis of a large national database

Anemia and Red Blood Cell Transfusions, Cerebral Oxygenation, Brain Injury and Development, and Neurodevelopmental Outcome in Preterm Infants: A Systematic Review

Prophylactic Erythropoietin for Neuroprotection in Very Preterm Infants: A Meta-Analysis Update

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