Effects of a Combined Therapy of Erythropoietin, Iron, Folate, and Vitamin B12 on the Transfusion Requirements of Extremely Low Birth Weight Infants

Haiden, Nadja; Schwindt, Jens; Cardona, Francesco; Berger, Angelika; Klebermass, K.; Wald, Martin; Kohlhauser-Vollmuth, C; Jilma, Bernd; Pollak, Arnold

doi:10.1542/peds.2006-1113

Cited by 48 publications

(26 citation statements)

References 45 publications

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“…In previous reports, EPO was shown to decrease the number of RBC transfusions in preterm infants [11,18,19,20,21]. Tempera et al [20] reported an association between EPO treatment and a decrease in ventilator days and speculated on the potential to reduce BPD rates [20].…”

Section: Discussionmentioning

confidence: 99%

“…They were not designed to detect a difference in BPD outcome. The study by Haiden et al [21], in 40 infants with a BW 450–800 g and GA ≤32 weeks, reported a decrease in transfusions in the EPO group which also had a higher proportion of infants requiring mechanical ventilation. There was no significant difference in incidence of BPD overall (6/21 or 29% vs. 8/19 or 42%).…”

Section: Discussionmentioning

confidence: 99%

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Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

et al. 2012

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Background: Despite advances in clinical care, the incidence of bronchopulmonary dysplasia (BPD) remains high in premature infants. Erythropoietin (EPO) is used for the treatment of anemia of prematurity (AOP) to decrease blood transfusion needs. EPO has been shown to mobilize circulating endothelial progenitor cells and to enhance lung repair in animal models. Objective: To determine whether EPO treatment for AOP was associated with a reduced incidence of BPD in premature infants. Methods: This retrospective study was performed on all live-born neonates with birth weights from 500 to 1,500 g and gestational age (GA) from 22 to 32 weeks admitted from 1994 to 2002. Infants who received EPO and those who did not receive EPO were compared for incidence of BPD and other morbidities. Results: Of478 patients, 297 received EPO before 36 weeks’ postmenstrual age (group 1) and 181 did not receive EPO (group 2). Group 1 was of similar birth weight but lower GA than group 2. The incidence of BPD was lower in group 1 than group 2 (26 vs. 36%, p = 0.03); after adjusting for significant risk factors, the adjusted odds ratio for BPD was 0.50 (95% CI 0.32, 0.79), p = 0.0028. The BPD rate was much lower when EPO was initiated before 4 weeks of age (16%) as compared to later initiation (44%). Conclusions: This study shows an association between EPO treatment and reduced incidence of BPD in preterm infants, particularly when EPO treatment was initiated within the first 4 weeks of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

et al. 2012

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“…In that study, the dose-response association between injected vitamin B 12 and levels of biomarkers was not estimated. (58) Only data on biomarkers Monsen et al (2006) (59) Does not address any relationships of interest Casanueva et al (2006) (60) Type of intervention: multivitamin supplement Choudhry et al (1972) (61) Study design: intervention but not RCT Cikot et al (2001) (62) Only data on biomarkers Couto et al (2007) (63) Only data on biomarkers Cornel et al (2005) (64) Irrelevant micronutrient Czeizel and Dudas (1992) (65) Type of intervention: multi-vitamin supplement Czeizel and Medveczky (2003) (66) Does not address any relationships of interest Dagnelie et al (1989) (67) Does not address any relationships of interest Dawson et al (2000) (68) Study design: intervention but not RCT van Dusseldorp et al (1999) (69) Study design: case-control study Eilander et al (2010) (70) Study design: cross-sectional study investigating S-H relationship Gomber et al (2003) (71) Study design: cross-sectional study investigating S-H relationship Gomber et al (1998) (72) Study design: cross-sectional study investigating S-H relationship Gordon and Carson (1976) (73) Study design: case report Graham et al (1992) (74) Population group: infants did not meet the inclusion criteria (unhealthy) Haggarty et al (2006) (75) Irrelevant health outcome (76) Type of intervention: multi-vitamin supplement …”

Section: Infantsmentioning

confidence: 99%

Association between vitamin B₁₂intake and EURRECA's prioritized biomarkers of vitamin B₁₂in young populations: a systematic review

Iglesia¹,

Dhonukshe-Rutten²,

Bel‐Serrat³

et al. 2012

Public Health Nutr.

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Objective: To review evidence on the associations between vitamin B 12 intake and its biomarkers, vitamin B 12 intake and its functional health outcomes, and vitamin B 12 biomarkers and functional health outcomes. Design: A systematic review was conducted by searching electronic databases, until January 2012, using a standardized strategy developed in the EURRECA network. Relevant articles were screened and sorted based on title and abstract, then based on full text, and finally included if they met inclusion criteria. A total of sixteen articles were included in the review. Setting: Articles covered four continents: America (n 4), Europe (n 8), Africa (n 1) and Asia (n 3). Subjects: Population groups included healthy infants, children and adolescents, and pregnant and lactating women. Results: From the total number of 5815 papers retrieved from the initial search, only sixteen were eligible according to the inclusion criteria: five for infants, five for children and adolescents, and six for pregnant and lactating women. Conclusions: Only one main conclusion could be extracted from this scarce number of references: a positive association between vitamin B 12 intake and serum vitamin B 12 in the infant group. Other associations were not reported in the eligible papers or the results were not provided in a consistent manner. The low number of papers that could be included in our systematic review is probably due to the attention that is currently given to research on vitamin B 12 in elderly people. Our observations in the current systematic review justify the idea of performing well-designed studies on vitamin B 12 in young populations.

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“…In addition, although not the primary outcome of the study, 59% of the Darbe recipients and 52% of the Epo recipients did not receive any transfusions during their hospitalization. Although previous studies outside the United States have achieved similar levels of success, 23 this is the first US study to report a .50% transfusion-free population of very low birth weight infants. Moreover, although the number of transfusions has decreased over the past 20 years, extremely low birth weight (ELBW) infants are still receiving 3 to 5 PRBC transfusions per hospitalization, and are being exposed to 2 to 3 donors.…”

Section: Figurementioning

confidence: 62%

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

Ohls¹,

Christensen

Kamath‐Rayne

et al. 2013

Pediatrics

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BACKGROUND: A novel erythropoiesis stimulating agent (ESA), darbepoetin alfa (Darbe), increases hematocrit in anemic adults when administered every 1 to 3 weeks. Weekly Darbe dosing has not been evaluated in preterm infants. We hypothesized that infants would respond to Darbe by decreasing transfusion needs compared with placebo, with less-frequent dosing than erythropoietin (Epo). METHODS: Preterm infants 500 to 1250 g birth weight and ≤48 hours of age were randomized to Darbe (10 μg/kg, 1 time per week subcutaneously), Epo (400 U/kg, 3 times per week subcutaneously) or placebo (sham dosing) through 35 weeks’ gestation. All received supplemental iron, folate, and vitamin E, and were transfused according to protocol. Transfusions (primary outcome), complete blood counts, absolute reticulocyte counts (ARCs), phlebotomy losses, and adverse events were recorded. RESULTS: A total of 102 infants (946 ± 196 g, 27.7 ± 1.8 weeks’ gestation, 51 ± 25 hours of age at first dose) were enrolled. Infants in the Darbe and Epo groups received significantly fewer transfusions (P = .015) and were exposed to fewer donors (P = .044) than the placebo group (Darbe: 1.2 ± 2.4 transfusions and 0.7 ± 1.2 donors per infant; Epo: 1.2 ± 1.6 transfusions and 0.8 ± 1.0 donors per infant; placebo: 2.4 ± 2.9 transfusions and 1.2 ± 1.3 donors per infant). Hematocrit and ARC were higher in the Darbe and Epo groups compared with placebo (P = .001, Darbe and Epo versus placebo for both hematocrit and ARCs). Morbidities were similar among groups, including the incidence of retinopathy of prematurity. CONCLUSIONS: Infants receiving Darbe or Epo received fewer transfusions and fewer donor exposures, and fewer injections were given to Darbe recipients. Darbepoetin and Epo successfully serve as adjuncts to transfusions in maintaining red cell mass in preterm infants.

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Effects of a Combined Therapy of Erythropoietin, Iron, Folate, and Vitamin B12 on the Transfusion Requirements of Extremely Low Birth Weight Infants

Abstract: Combined treatment with erythropoietin, intravenous iron, folate, and vitamin B12 during the first weeks reduces the need for transfusion in extremely low birth weight infants.

Cited by 48 publications

References 45 publications

Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

Association between vitamin B₁₂intake and EURRECA's prioritized biomarkers of vitamin B₁₂in young populations: a systematic review

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

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Effects of a Combined Therapy of Erythropoietin, Iron, Folate, and Vitamin B12 on the Transfusion Requirements of Extremely Low Birth Weight Infants

Abstract: Combined treatment with erythropoietin, intravenous iron, folate, and vitamin B12 during the first weeks reduces the need for transfusion in extremely low birth weight infants.

Cited by 48 publications

References 45 publications

Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

Association between vitamin B12intake and EURRECA's prioritized biomarkers of vitamin B12in young populations: a systematic review

A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants

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Association between vitamin B₁₂intake and EURRECA's prioritized biomarkers of vitamin B₁₂in young populations: a systematic review