Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants

Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks’ gestation: a randomised controlled trial

“…On the basis of the results of the previous meta-analysis of early versus delayed umbilical cord clamping, which had shown that the relative risk of transfusions for anaemia in the early clamping group was 2.01 (95% CI 1.24 to 3.27),5 a sample size calculation determined that 17 babies in each group would be needed to show a 45% difference between the two groups, with a two-sided α of 0.05 and 80% power.…”

“…The current Cochrane review by Aher et al showed that early or late administration of recombinant human erythropoietin (rHu-EPO) reduced the RBC transfusions in VLBW 3 4. However, they concluded that early administration of rHu-EPO is not recommended because the small reductions of RBC transfusion were of limited clinical importance and there was a significant increase in the risk of stage ⩾3 retinopathy of prematurity 5. ELBW infants still have the greatest risk for needing RBC transfusions within the first 3 weeks of life, owing to combined therapy of rHu-EPO, iron, folate and vitamin B12 6…”

Rationale of a Cohort Study on Risk of Obstetrical Outcomes Associated with Iron Supplementation during Pregnancy

“…Furthermore, there has been abundant literature admitting close relationships between maternal oxidative stress and body or serum iron status [17] [18] [19], meaning that iron supplementation might bring a risk for both mother and infant, which makes it difficult to delineate the mutual part of anemia and supplemented iron in occurrence of obstetrical outcomes. Besides, although current literature obviously relates this potential risk to absorbed iron our study aims to question also unabsorbed iron.…”

Receptor-Based Dosing Optimization of Erythropoietin in Juvenile Sheep after Phlebotomy

“…There have been a number of clinical trials in which Epo was administered to preterm infants with the goal of reducing or eliminating the need for blood transfusions. A review study done on 27 different Epo clinical trials with preterm infants concluded that although Epo administration reduces the use of RBC transfusions and the quantity of RBCs transfused, these reductions were claimed to be of limited clinical importance (Ohlsson and Aher, 2006). However, because these published clinical trials used a "trial and error" methodology that does not consider the complex PK/PD of Epo, it is not clear how well they can be used as a guide to the real benefit of Epo when Epo is optimally administered to anemic infants.…”

“…However, the benefit of Epo therapy in anemic preterm infants is still under investigation. Clinical trials involving Epo administration in preterm infants have shown some significant results, although the clinical significance is inconsistent (Ohlsson and Aher, 2006). Young sheep have previously been used to model human anemia (Veng-Pedersen et al, 1999) and may provide guidelines for how to optimally administer Epo in preterm infants.…”