The Effect of Early Recombinant Erythropoietin and Enteral Iron Supplementation on Blood Transfusion in Preterm Infants

Turker, Gülcan; Sarper, Nazan; Gökalp, Ayşe Sevim; Usluer, Hale

doi:10.1055/s-2005-918888

Cited by 20 publications

(25 citation statements)

References 39 publications

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“…The ability of early use of erythropoietin to reduce the incidence of BPD and requirement of blood transfusion has been described previously2728. Furthermore, the use of supplemental iron and implementation of more stringent transfusion guidelines can also decrease the need for transfusion2930.…”

Section: Discussionmentioning

confidence: 98%

Association between Red Blood Cell Transfusion and Bronchopulmonary Dysplasia in Preterm Infants

Zhang

Huang

2014

Sci Rep

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Anemia and the need for transfusion of packed red blood cells (PRBCs) are common in preterm infants. PRBC transfusion increases the oxygen carrying capacity of hemoglobin and may result in higher rates of organ dysfunction. To determine whether PRBC transfusion in preterm infants is associated with an increased incidence of bronchopulmonary dysplasia (BPD), this retrospective study was performed on neonates with birth weights ≤ 1,500 g or gestational age ≤ 32 weeks admitted from August, 2008 to November, 2013. Infants who received PRBC transfusion before the diagnosis of BPD and those who did not receive PRBC transfusion or received PRBC transfusion after diagnosis of BPD were compared for incidence of BPD and other morbidities. Of 231 preterm infants, 137 received PRBC transfusion before BPD was diagnosed (group 1) and 94 did not (group 2). The incidence of BPD was significantly higher in group 1 than in group 2 (37.2% vs. 2.1%, P < 0.00001). After adjusting for potential risk factors, the adjusted odds ratio for BPD was 9.80 (95% confidence interval, 1.70–56.36; P = 0.01). This study demonstrated an association between PRBC transfusion and BPD in preterm infants. A cautious approach to PRBC transfusion in these infants is warranted.

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Section: Discussionmentioning

confidence: 98%

Association between Red Blood Cell Transfusion and Bronchopulmonary Dysplasia in Preterm Infants

Zhang

Huang

2014

Sci Rep

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“…Studies on the use of Epo during the neonatal period have increased in recent years (Shannon et al 1991;Gumy-Pause et al 2005). Some studies did not find an increase of retinopathy associated with Epo use, whereas others observed an increase in ROP incidence with the administration of rhEpo (Donato et al 2000;Romagnoli et al 2000;Maier et al 2002;Turker et al 2005;Brown et al 2006;Shah et al 2010). A meta-analysis conducted by Ohlsson and Aher found an increase in severe ROP (stage 3) in patients treated with rhEpo compared to controltreated patients and an increase in all stages when the treatments were started within the first 8 days of life (Aher & Ohlsson 2006;Ohlsson & Aher 2006).…”

Section: The Role Of Erythropoietin (Epo)mentioning

confidence: 99%

The pathophysiology of retinopathy of prematurity: an update of previous and recent knowledge

Cavallaro

Filippi

Bagnoli

et al. 2013

Acta Ophthalmologica

166

143

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ABSTRACT.Retinopathy of prematurity (ROP) is a disease that can cause blindness in very low birthweight infants. The incidence of ROP is closely correlated with the weight and the gestational age at birth. Despite current therapies, ROP continues to be a highly debilitating disease. Our advancing knowledge of the pathogenesis of ROP has encouraged investigations into new antivasculogenic therapies. The purpose of this article is to review the findings on the pathophysiological mechanisms that contribute to the transition between the first and second phases of ROP and to investigate new potential therapies. Oxygen has been well characterized for the key role that it plays in retinal neoangiogenesis. Low or high levels of pO 2 regulate the normal or abnormal production of hypoxia-inducible factor 1 and vascular endothelial growth factors (VEGF), which are the predominant regulators of retinal angiogenesis. Although low oxygen saturation appears to reduce the risk of severe ROP when carefully controlled within the first few weeks of life, the optimal level of saturation still remains uncertain. IGF-1 and Epo are fundamentally required during both phases of ROP, as alterations in their protein levels can modulate disease progression. Therefore, rhIGF-1 and rhEpo were tested for their abilities to prevent the loss of vasculature during the first phase of ROP, whereas anti-VEGF drugs were tested during the second phase. At present, previous hypotheses concerning ROP should be amended with new pathogenetic theories. Studies on the role of genetic components, nitric oxide, adenosine, apelin and b-adrenergic receptor have revealed new possibilities for the treatment of ROP. The genetic hypothesis that single-nucleotide polymorphisms within the b-ARs play an active role in the pathogenesis of ROP suggests the concept of disease prevention using b-blockers. In conclusion, all factors that can mediate the progression from the avascular to the proliferative phase might have significant implications for the further understanding and treatment of ROP.Key words: erythropoietin -hypoxia-inducible factor 1 -insulin-like growth factor-1 -neovascularization -pathophysiology -placental growth factor -retinopathy of prematurity -vascular endothelial growth factor -b-adrenergic receptors Acta Ophthalmol. 2014: 92: 2-20

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“…These were further categorized into studies on the effect of human milk, 21 10,[65][66][67][68] and the other 13 studied the effect of exogenous erythropoietin (EPO) on the risk of ROP. [69][70][71][72][73][74][75][76][77][78][79][80][81] All 5 studies of infection prevention pertained to the effect of fluconazole prophylaxis. [82][83][84][85][86] …”

Section: Study Characteristicsmentioning

confidence: 99%

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang¹,

Sorita²,

Carey³

et al. 2016

Pediatrics

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CONTEXT: The effectiveness of many interventions aimed at reducing the risk of retinopathy has not been well established. OBJECTIVE:To estimate the effectiveness of nutritional interventions, oxygen saturation targeting, blood transfusion management, and infection prevention on the incidence of retinopathy of prematurity (ROP). DATA SOURCES:A comprehensive search of several databases was conducted, including Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through March 2014. STUDY SELECTION:We included studies that evaluated nutritional interventions, management of supplemental oxygen, blood transfusions, or infection reduction and reported the incidence of ROP and mortality in neonates born at <32 weeks. DATA EXTRACTION:We extracted patient characteristics, interventions, and risk of bias indicators. Outcomes of interest were any stage ROP, severe ROP or ROP requiring treatment, and mortality. RESULTS:We identified 67 studies enrolling 21 819 infants. Lower oxygen saturation targets reduced the risk of developing any stage ROP (relative risk [RR] 0.86, 95% confidence interval [CI], 0.77-0.97) and severe ROP or ROP requiring intervention (RR 0.58, 95% CI, 0.45-0.74) but increased mortality (RR 1.15, 95% CI, 1.04-1.29). Aggressive parenteral nutrition reduced the risk of any stage ROP but not severe ROP. Supplementation of vitamin A, E, or inositol and breast milk feeding were beneficial but only in observational studies. Use of transfusion guidelines, erythropoietin, and antifungal agents were not beneficial. LIMITATIONS:Results of observational studies were not replicated in randomized trials. Interventions were heterogeneous across studies. CONCLUSIONS:At the present time, there are no safe interventions supported with high quality evidence to prevent severe ROP.

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The Effect of Early Recombinant Erythropoietin and Enteral Iron Supplementation on Blood Transfusion in Preterm Infants

Cited by 20 publications

References 39 publications

Association between Red Blood Cell Transfusion and Bronchopulmonary Dysplasia in Preterm Infants

Association between Red Blood Cell Transfusion and Bronchopulmonary Dysplasia in Preterm Infants

The pathophysiology of retinopathy of prematurity: an update of previous and recent knowledge

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

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