The Use of Erythropoietin for Anemia of Prematurity in North of Jordan, Outcome and Impact on Blood Transfusion

Abstract

Background: Anemia of prematurity (AOP) is a common problem affecting preterm babies admitted to the neonatal intensive care unit particularly those born with very low birth weight (VLBW <1500 grams). Erythropoietin (EPO) has been recognized as one of the therapeutic options since the 1980's. However, blood transfusion is still used for treating AOP at different thresholds, even in non-emergent situations. In late 2015, we created an EPO initiative for treatment of AOP in our unit at King Abdullah University Hospital. Objective: To describe the use of EPO in cases of AOP in our VLBW infant population and review its effect on reducing the need for blood transfusion. We also monitored the laboratory response to EPO and evaluated the association with retinopathy of prematurity in babies who received this therapy. Methods: We conducted a retrospective cohort review of VLBW premature babies with AOP who received EPO during their stay at our unit between October 2015 and October 2016, and compared them with same number of controls. Collected data included demographics, age at EPO initiation, hemoglobin and reticulocyte count pre and post EPO therapy , timing and dosing of EPO, the dose of iron supplement, the need for blood transfusion before and after therapy, and the presence of retinopathy of prematurity (ROP), other comorbidities and mortality. Results: 36 VLBW babies received EPO during the study period and were compared with 36 control cases. Babies in the EPO group received blood transfusion less frequently than the controls {Median number of transfusions 1 (1, 2) vs 2 (2, 2), p 0.006}. Response to EPO therapy manifests with a surge in reticulocyte count {5 (2, 7.7) vs 1 (1, 1.3), p 0.04}. There was no difference in the risk of high stage ROP between both groups. Conclusion: EPO is considered a safe therapy for AOP in stable VLBW infants at our unit. We need to establish or adapt and implement a more structured policy to guide us in treatment of AOP with either therapy.