Carbonell Estrany X, Figueras Aloy J, Pérez Fernández J M, Fernández López A, González Luis G, Salvía Roiges M D
Servicio de Neonatología, Hospital Clínic-Maternitat, Universitat de Barcelona, IDIBAPS.
An Esp Pediatr. 1999 Sep;51(3):281-6.
Our objective was to analyze the utility of treatment with erythropoietin (EPO) plus iron in decreasing the need of late transfusions and reaching hematocrit > or = 32% in preterm infants of < or = 32 weeks of gestation.
Between March 1996 and October 1998, preterm infants of one unit were considered as the control group, while another group in another unit in the same hospital were treated with EPO (250 U/Kg, 3 times a week, subcutaneously) from day 7 of life until 37 weeks 37 post-conception. Oral iron was added to treatment one week later (5 mg/Kg, and increased in order to keep ferritin levels > 100 ng/ml). More strict transfusion criteria were established. Weights were stratified in < 1,000 g, 1,000-1,249 g and > or = 1,250 g.
Blood losses during the first 2 weeks were higher in the control group and that was probably the reason for the increased number of transfusions during the first 10 days of life. Late transfusions decreased in the EPO treated group (p < 0.0003). This was significant after the 3rd week and in the 1,000-1,249 g weight group. The EPO-treated group showed lower hematocrit < or = 32% (p < 0.001). When EPO-treated infants were separately analyzed it was clear that late transfusions were more frequent in infants that were smaller, more immature and sicker and with higher blood losses. The reticulocyte count increase was similar in both groups of late transfused vs. Not transfused EPO-treated infants, being higher at 4 weeks after EPO was started (30/1000). EPO and ferritin values were always higher in late transfused EPO-treated infants than in non-transfused infants.
The EPO plus iron treated group of preterm infants had a 40% decrease in the need for late transfusions in comparison with the control group. The best results were obtained in the 1000-1249 g group of preterm infants.
我们的目的是分析促红细胞生成素（EPO）联合铁剂治疗在减少晚期输血需求以及使胎龄≤32周的早产儿血细胞比容≥32%方面的效用。
1996年3月至1998年10月，一个单位的早产儿被视为对照组，而同一医院另一个单位的另一组早产儿从出生第7天至孕37周后接受EPO治疗（250 U/kg，每周3次，皮下注射）。1周后在治疗中添加口服铁剂（5 mg/kg，并根据情况增加剂量以维持铁蛋白水平>100 ng/ml）。制定了更严格的输血标准。体重分为<1000 g、1000 - 1249 g和≥1250 g。
对照组前2周的失血量更高，这可能是出生后前10天输血次数增加的原因。EPO治疗组的晚期输血次数减少（p<0.0003）。在第3周后以及1000 - 1249 g体重组中这一差异具有统计学意义。EPO治疗组血细胞比容≤32%的情况较少（p<0.001）。当单独分析接受EPO治疗的婴儿时，很明显，较小、更不成熟、病情更重且失血量更高的婴儿晚期输血更频繁。两组接受晚期输血与未接受输血的EPO治疗婴儿的网织红细胞计数增加情况相似，在开始使用EPO后4周时更高（30/1000）。接受晚期输血的EPO治疗婴儿的EPO和铁蛋白值始终高于未接受输血的婴儿。
与对照组相比，EPO联合铁剂治疗的早产儿组晚期输血需求减少了40%。在1000 - 1249 g的早产儿组中取得了最佳效果。
