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Reibel-Georgi NJ, Scrivens A, Heeger LE, Lopriore E, New HV, Deschmann E, Stanworth SJ, Carrascosa MA, Brække K, Cardona F, Cools F, Farrugia R, Ghirardello S, Krivec JL, Matasova K, Muehlbacher T, Sankilampi U, Soares H, Szabó M, Szczapa T, Zaharie G, Roehr CC, Fustolo-Gunnink S, Dame C. Supplemental Iron and Recombinant Erythropoietin for Anemia in Infants Born Very Preterm: A Survey of Clinical Practice in Europe. J Pediatr 2024; 276:114302. [PMID: 39277077 DOI: 10.1016/j.jpeds.2024.114302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/27/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES To survey practices of iron and recombinant human erythropoietin (rhEpo) administration to infants born preterm across Europe. STUDY DESIGN Over a 3-month period, we conducted an online survey in 597 neonatal intensive care units (NICUs) of 18 European countries treating infants born with a gestational age of <32 weeks. RESULTS We included 343 NICUs (response rate 56.3%) in the survey. Almost all NICUs (97.7%) routinely supplement enteral iron, and 74.3% of respondents to all infants born <32 weeks of gestation. We found that 65.3% of NICUs routinely evaluate erythropoiesis and iron parameters beyond day 28 after birth. Most NICUs initiate iron supplementation at postnatal age of 2 weeks and stop after 6 months (34.3%) or 12 months (34.3%). Routine use of rhEpo was reported in 22.2% of NICUs, and in individual cases in 6.9%. RhEpo was mostly administered subcutaneously (70.1%) and most frequently at a dose of 250 U/kg 3 times a week (44.3%), but the dose varied greatly between centers. CONCLUSIONS This survey highlights wide heterogeneity in evaluating erythropoietic activity and iron deficiency in infants born preterm. Variation in iron supplementation during infancy likely reflects an inadequate evidence base. Current evidence on the efficacy and safety profile of rhEpo is only poorly translated into clinical practice. This survey demonstrates a need for standards to optimize patient blood management in anemia of prematurity.
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Affiliation(s)
- Nora J Reibel-Georgi
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Scrivens
- Newborn Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lisanne E Heeger
- Sanquin Research & Lab Services, Blood Supply Foundation, Amsterdam, The Netherlands; Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Helen V New
- Pediatric Transfusion Medicine, National Health Service Blood and Transplant, London, UK
| | - Emöke Deschmann
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Simon J Stanworth
- Department of Hematology, National Health Service, Blood and Transplant (NHSBT), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Kristin Brække
- Department of Neonatology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Francesco Cardona
- Division of Neonatology, Intensive Care and Pediatric Neurology, Medical University of Vienna, Vienna, Austria
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Stefano Ghirardello
- Department of Neonatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jana Lozar Krivec
- Department of Neonatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Katarina Matasova
- Department of Neonatology, Jessensius Faculty of Medicine, Martin University Hospital, Martin, Slovakia
| | - Tobias Muehlbacher
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Henrique Soares
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Miklós Szabó
- Department of Neonatology, Pediatric Centre, Semmelweis University, Budapest, Hungary
| | - Tomasz Szczapa
- II Department of Neonatology, Poznań University of Medical Sciences, Poznan, Poland
| | - Gabriela Zaharie
- Department of Neonatology, University of Medicine and Pharmacy Iuliu Hatieganu Cluj, Cluj Napoca, Romania
| | - Charles Christoph Roehr
- Women and Children's, Neonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; Faculty of Health Sciences, University of Bristol, Bristol, UK; National Perinatal Epidemiology Unit, Clinical Trials Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Suzanne Fustolo-Gunnink
- Sanquin Research & Lab Services, Blood Supply Foundation, Amsterdam, The Netherlands; Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands; Pediatric Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Christof Dame
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Connolly JM, McClary JD, Desai R, Sundaram A, Neudecker M, Nock ML, Ryan RM, Marasch JL. Efficacy of recombinant erythropoietin for the late treatment of anemia of prematurity in a level IV neonatal intensive care unit: a retrospective single-center cohort study. J Perinatol 2024; 44:892-896. [PMID: 38773216 DOI: 10.1038/s41372-024-02001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To describe the population to which we administered recombinant erythropoietin and to determine the effectiveness of this treatment as quantified by the change in hematocrit. STUDY DESIGN This retrospective chart review study included infants who received erythropoietin for the treatment of anemia of prematurity. RESULTS There were 132 infants representing 162 unique treatment courses included in the study. The average duration of therapy was 9 days (±7) and 6 doses (±2). The average change in hematocrit (Hct) was 6.2% (SD 3.9%, p < 0.001). Rise in Hct was associated with a higher number of rEPO doses (p < 0.001) and higher postmenstrual age (p < 0.001). In our small cohort we did not find an association between the number of rEPO doses and retinopathy of prematurity (ROP) requiring treatment. CONCLUSION Erythropoietin is safe and effective at treating anemia of prematurity as evidenced by a clinically and statistically significant increase in Hct from baseline.
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Affiliation(s)
- Jillian M Connolly
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Jacquelyn D McClary
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Riddhi Desai
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Anupama Sundaram
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Mandy Neudecker
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Mary L Nock
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rita M Ryan
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jaime L Marasch
- UH Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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Costescu OC, Manea AM, Boia ER, Cioboata DM, Doandes FM, Enatescu I, Costescu S, Prodan M, Boia M. Early Postnatal Administration of Erythropoietin and Its Association with Neurodevelopmental Outcomes and Incidence of Intraventricular Hemorrhage and Hypoxic-Ischemic Encephalopathy: A Four-Week Observational Study. Pediatr Rep 2024; 16:339-352. [PMID: 38804373 PMCID: PMC11130859 DOI: 10.3390/pediatric16020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
This study aimed to investigate the impact of early erythropoietin (EPO) administration on the neurodevelopment of newborns, specifically focusing on its effects on hypoxic-ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH). The primary objective was to determine whether early EPO administration could impact the short-term neurodevelopmental outcomes and provide safety in neonates at risk for neurodevelopmental disorders. Conducted at the "Louis Turcanu" Children's Emergency Clinical Hospital in Timisoara, Romania, this observational study included 121 neonates receiving EPO and 130 No EPO controls. EPO was administered within the first 48 h of life, with doses of 1000 U/kg that escalated to 2000 U/kg if necessary. Besides observing the occurrence of IVH and HIE, this study measured clinical and biochemical markers, including LDH, blood glucose, urea, creatinine, CPK, CRP, PCT, and erythropoietin levels alongside hematology and coagulation profiles. There were no significant differences in baseline characteristics between the groups. The EPO group showed significant reductions in LDH levels from days 1-3 to 7-10 (695.0 U/L to 442.0 U/L) and the APTT value (54.0 s) compared with the No EPO group (38.0 s). Notably, early EPO administration was associated with a significant decrease in HIE severity (beta coefficient: -0.38, p = 0.001). Additionally, lower gestational ages and hemoglobin levels correlated with increased severity of HIE. By week four, there was a significant reduction in moderate and severe HIE cases in the EPO group compared with controls (p = 0.001). Early administration of EPO in neonates significantly reduced the severity of IVH and HIE, suggesting its potential as a neuroprotective agent in neonatal care.
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Affiliation(s)
- Oana Cristina Costescu
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Aniko Maria Manea
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
| | - Eugen Radu Boia
- ENT Department, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Daniela Mariana Cioboata
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Florina Marinela Doandes
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
| | - Ileana Enatescu
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
| | - Sergiu Costescu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department of Obstetrics and Gynecology, Oravita City Hospital, 325600 Oravita, Romania
| | - Mihaela Prodan
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Marioara Boia
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
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Costescu OC, Boia ER, Boia M, Cioboata DM, Doandes FM, Lungu N, Dinu M, Iacob ER, Manea AM. The Role of Erythropoietin in Preventing Anemia in the Premature Neonate. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1843. [PMID: 38136044 PMCID: PMC10742248 DOI: 10.3390/children10121843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Recombinant human erythropoietin (rhEPO) treatment is an alternative to red blood cell (RBC) transfusions in neonates presenting anemia of prematurity (AOP). This study assesses the impact of early rhEPO administration on AOP (any stage) incidence, as well as the incidence of individual AOP stages and RBC transfusions. Out of 108 preterm neonates, 49 were administered rhEPO and compared to the remaining group using univariate and multivariate analyses. Univariately, gestational age (GA), birth weight (BW), hemoglobin (Hb), hematocrit (HCT), RBC levels, and iron administration were significantly associated with AOP (p < 0.05 each); however, only the latter remained significant following multivariate analysis (AOR: 2.75, 95% CI, 1.06-7.11). Multinomial analysis revealed rhEPO treatment was associated with a near three-fold reduction in moderate AOP incidence (OR: 0.36, 95% CI, 0.15-0.89). Furthermore, ANCOVA revealed positive correlations between rhEPO administration and 21-day Hb (p < 0.01), HCT (p < 0.05), and EPO (p < 0.001) levels. The results confirm previously reported benefits of rhEPO treatment, such as reduced moderate AOP incidence and increased Hb, HCT, and serum EPO levels.
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Affiliation(s)
- Oana Cristina Costescu
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (M.B.); (D.M.C.); (F.M.D.); (N.L.); (E.R.I.); (A.M.M.)
| | - Eugen Radu Boia
- ENT Department, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania
| | - Marioara Boia
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (M.B.); (D.M.C.); (F.M.D.); (N.L.); (E.R.I.); (A.M.M.)
| | - Daniela Mariana Cioboata
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (M.B.); (D.M.C.); (F.M.D.); (N.L.); (E.R.I.); (A.M.M.)
- PhD School Department, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Florina Marinela Doandes
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (M.B.); (D.M.C.); (F.M.D.); (N.L.); (E.R.I.); (A.M.M.)
| | - Nicoleta Lungu
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (M.B.); (D.M.C.); (F.M.D.); (N.L.); (E.R.I.); (A.M.M.)
| | - Mihai Dinu
- Faculty of Medical Engineering, University “Politehnica” of Bucharest, Gheorghe Polizu Street, No. 1–7, 011061 Bucharest, Romania;
| | - Emil Radu Iacob
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (M.B.); (D.M.C.); (F.M.D.); (N.L.); (E.R.I.); (A.M.M.)
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Aniko Maria Manea
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (M.B.); (D.M.C.); (F.M.D.); (N.L.); (E.R.I.); (A.M.M.)
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