Top

Published in:

Open Access 01-12-2013 | Research article

Respective effects of phlebotomy losses and erythropoietin treatment on the need for blood transfusion in very premature infants

Authors: Odile Becquet, Delphine Guyot, Philippe Kuo, Françoise Pawlotsky, Marianne Besnard, Micheline Papouin, Alexandre Lapillonne

Published in: BMC Pediatrics | Issue 1/2013

Abstract

Background

The benefit to risk ratio of the treatment with erythropoietin (EPO) as a means of limiting the number of transfusions in very preterm infants during hospitalization, seems to be modest since the adoption of restrictive transfusion criteria and of policy limiting phlebotomy losses. We therefore aim to evaluate the factors associated with the number of late blood transfusion in very preterm infants in a unit where the routine use of EPO has been discontinued.

Methods

A comparative “before-after” study was carried out in premature infants born before 32 weeks postmenstrual age (PMA), over a period of one year before (EPO group) and one year after (non-EPO group) the discontinuation of EPO therapy.

Results

A total of 48 infants were included in the study (EPO=21; non-EPO=27). The number of infants transfused after the 15 day of life (D15) and the number of transfusions per infant after D15 were not significantly different between the two groups. In a multivariate analysis, the gestational age and the volume of blood drawn off during the first month of life significantly influenced the need for transfusions after the 15th day of life, independently of the treatment with EPO. The hemoglobin levels measured at different times of hospitalization (median postnatal age: 16, 33 and 67 days) were not significantly different between the two groups.

Conclusions

Our study shows that the discontinuation of EPO did not change the number of late transfusions. Even when a policy limiting phlebotomy losses is used, blood loss is an important and independent risk factor for late transfusion of very preterm infants.

Halperin DS, Wacker P, Lacourt G, Felix M, Babel JF, Aapro M, Wyss M: Effects of recombinant human erythropoietin in infants with the anemia of prematurity: a pilot study. J Pediatr. 1990, 116 (5): 779-786. 10.1016/S0022-3476(05)82671-X.CrossRefPubMed

Messer J, Haddad J, Donato L, Astruc D, Matis J: Early treatment of premature infants with recombinant human erythropoietin. Pediatrics. 1993, 92 (4): 519-523.PubMed

Maier RF, Obladen M, Scigalla P, Linderkamp O, Duc G, Hieronimi G, Halliday HL, Versmold HT, Moriette G, Jorch G, et al: The effect of epoetin beta (recombinant human erythropoietin) on the need for transfusion in very-low-birth-weight infants. European Multicentre Erythropoietin Study Group. The New England journal of medicine. 1994, 330 (17): 1173-1178.CrossRef

Soubasi V, Kremenopoulos G, Diamandi E, Tsantali C, Tsakiris D: In which neonates does early recombinant human erythropoietin treatment prevent anemia of prematurity? Results of a randomized, controlled study. Pediatr Res. 1993, 34 (5): 675-679. 10.1203/00006450-199311000-00022.CrossRefPubMed

Emmerson AJ, Coles HJ, Stern CM, Pearson TC: Double blind trial of recombinant human erythropoietin in preterm infants. Arch Dis Child. 1993, 68 (3 Spec No): 291-296. 10.1136/adc.68.3_Spec_No.291.CrossRefPubMedPubMedCentral

Ohls RK, Christensen RD, Kamath-Rayne BD, Rosenberg A, Wiedmeier SE, Roohi M, Lacy CB, Lambert DK, Burnett JJ, Pruckler B, et al: A randomized, masked, placebo-controlled study of darbepoetin alfa in preterm infants. Pediatrics. 2013, 132 (1): e119-127. 10.1542/peds.2013-0143.CrossRefPubMedPubMedCentral

Lin JC, Strauss RG, Kulhavy JC, Johnson KJ, Zimmerman MB, Cress GA, Connolly NW, Widness JA: Phlebotomy overdraw in the neonatal intensive care nursery. Pediatrics. 2000, 106 (2): E19-10.1542/peds.106.2.e19.CrossRefPubMed

Franz AR, Pohlandt F: Red blood cell transfusions in very and extremely low birthweight infants under restrictive transfusion guidelines: is exogenous erythropoietin necessary?. Arch Dis Child Fetal Neonatal Ed. 2001, 84 (2): F96-F100. 10.1136/fn.84.2.F96.CrossRefPubMedPubMedCentral

Strauss RG: Controversies in the management of the anemia of prematurity using single-donor red blood cell transfusions and/or recombinant human erythropoietin. Transfus Med Rev. 2006, 20 (1): 34-44. 10.1016/j.tmrv.2005.08.003.CrossRefPubMed

10.

Bishara N, Ohls RK: Current controversies in the management of the anemia of prematurity. Semin Perinatol. 2009, 33 (1): 29-34. 10.1053/j.semperi.2008.10.006.CrossRefPubMed

11.

Vamvakas EC, Strauss RG: Meta-analysis of controlled clinical trials studying the efficacy of rHuEPO in reducing blood transfusions in the anemia of prematurity. Transfusion. 2001, 41 (3): 406-415. 10.1046/j.1537-2995.2001.41030406.x.CrossRefPubMed

12.

Ohls RK, Ehrenkranz RA, Wright LL, Lemons JA, Korones SB, Stoll BJ, Stark AR, Shankaran S, Donovan EF, Close NC, et al: Effects of early erythropoietin therapy on the transfusion requirements of preterm infants below 1250 grams birth weight: a multicenter, randomized, controlled trial. Pediatrics. 2001, 108 (4): 934-942. 10.1542/peds.108.4.934.CrossRefPubMed

13.

Maier RF, Obladen M, Muller-Hansen I, Kattner E, Merz U, Arlettaz R, Groneck P, Hammer H, Kossel H, Verellen G, et al: Early treatment with erythropoietin beta ameliorates anemia and reduces transfusion requirements in infants with birth weights below 1000 g. J Pediatr. 2002, 141 (1): 8-15. 10.1067/mpd.2002.124309.CrossRefPubMed

14.

Aher SM, Ohlsson A: Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2006, 3: CD004865

15.

Freise KJ, Widness JA, Veng-Pedersen P: Erythropoietic response to endogenous erythropoietin in premature very low birth weight infants. J Pharmacol Exp Ther. 2010, 332 (1): 229-237. 10.1124/jpet.109.159905.CrossRefPubMedPubMedCentral

16.

Aher S, Ohlsson A: Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2006, 3: CD004868

17.

Ohlsson A, Aher SM: Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2006, 3: CD004863

18.

AFSSAPS: Transfusion de Globules rouges homologues : produits, indications, alternatives. Methode générale, Recommandation. Transfus Clin Biol. 2002, 9: 33-56. 10.1016/S1246-7820(01)00213-0.CrossRef

19.

Aher SM, Ohlsson A: Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2012, 10: CD004865

20.

Carbajal R, Lenclen R, Gajdos V, Jugie M, Paupe A: Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections. Pediatrics. 2002, 110 (2 Pt 1): 389-393.CrossRefPubMed

21.

Beeby PJ, Bhutap T, Taylor LK: New South Wales population-based birthweight percentile charts. J Paediatr Child Health. 1996, 32 (6): 512-518. 10.1111/j.1440-1754.1996.tb00965.x.CrossRefPubMed

22.

Papile LA, Burstein J, Burstein R, Koffler H: Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978, 92 (4): 529-534. 10.1016/S0022-3476(78)80282-0.CrossRefPubMed

23.

Whyte R, Kirpalani H: Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. Cochrane Database Syst Rev. 2011, 11: CD000512

24.

Birenbaum HJ, Pane MA, Helou SM, Starr KP: Comparison of a restricted transfusion schedule with erythropoietin therapy versus a restricted transfusion schedule alone in very low birth weight premature infants. South Med J. 2006, 99 (10): 1059-1062. 10.1097/01.smj.0000233213.28362.3b.CrossRefPubMed

25.

Trentesaux AS, Egreteau L, Santerne B, Morville P: Recombinant human erythropoietin in premature infants. Evaluation of a one year experience. Arch Pediatr. 1999, 6 (9): 944-951. 10.1016/S0929-693X(99)80586-7.CrossRefPubMed

26.

Donato H, Vain N, Rendo P, Vivas N, Prudent L, Larguia M, Digregorio J, Vecchiarelli C, Valverde R, Garcia C, et al: Effect of early versus late administration of human recombinant erythropoietin on transfusion requirements in premature infants: results of a randomized, placebo-controlled, multicenter trial. Pediatrics. 2000, 105 (5): 1066-1072. 10.1542/peds.105.5.1066.CrossRefPubMed

27.

Haiden N, Schwindt J, Cardona F, Berger A, Klebermass K, Wald M, Kohlhauser-Vollmuth C, Jilma B, Pollak A: Effects of a combined therapy of erythropoietin, iron, folate, and vitamin B12 on the transfusion requirements of extremely low birth weight infants. Pediatrics. 2006, 118 (5): 2004-2013. 10.1542/peds.2006-1113.CrossRefPubMed

28.

Khatami SF, Mamouri G, Torkaman M: Effects of early human recombinant erythropoietin therapy on the transfusion in healthy preterm infants. Indian J Pediatr. 2008, 75 (12): 1227-1230. 10.1007/s12098-008-0225-0.CrossRefPubMed

29.

Tempera A, Stival E, Piastra M, De Luca D, Ottaviano C, Tramontozzi P, Marconi M, Cafforio C, Marcozzi P, Rossi N, et al: Early erythropoietin influences both transfusion and ventilation need in very low birth weight infants. J Matern Fetal Neonatal Med. 2011, 24 (8): 1060-1064. 10.3109/14767058.2010.545917.CrossRefPubMed

30.

Ohlsson A, Aher SM: Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2012, 9: CD004863

31.

Guillen U, Cummings JJ, Bell EF, Hosono S, Frantz AR, Maier RF, Whyte RK, Boyle E, Vento M, Widness JA, et al: International survey of transfusion practices for extremely premature infants. Semin Perinatol. 2012, 36 (4): 244-247. 10.1053/j.semperi.2012.04.004.CrossRefPubMedPubMedCentral

32.

Whyte RK, Kirpalani H, Asztalos EV, Andersen C, Blajchman M, Heddle N, LaCorte M, Robertson CM, Clarke MC, Vincer MJ, et al: Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics. 2009, 123 (1): 207-213. 10.1542/peds.2008-0338.CrossRefPubMed

33.

Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ, Cress GA, Johnson KJ, Kromer IJ, Zimmerman MB: Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics. 2005, 115 (6): 1685-1691. 10.1542/peds.2004-1884.CrossRefPubMedPubMedCentral

34.

McCoy TE, Conrad AL, Richman LC, Lindgren SD, Nopoulos PC, Bell EF: Neurocognitive profiles of preterm infants randomly assigned to lower or higher hematocrit thresholds for transfusion. Child Neuropsychol. 2011, 17 (4): 347-367. 10.1080/09297049.2010.544647.CrossRefPubMedPubMedCentral

35.

Nopoulos PC, Conrad AL, Bell EF, Strauss RG, Widness JA, Magnotta VA, Zimmerman MB, Georgieff MK, Lindgren SD, Richman LC: Long-term outcome of brain structure in premature infants: effects of liberal vs restricted red blood cell transfusions. Arch Pediatr Adolesc Med. 2011, 165 (5): 443-450. 10.1001/archpediatrics.2010.269.CrossRefPubMedPubMedCentral

36.

Kling PJ, Sullivan TM, Leftwich ME, Roe DJ: Score for neonatal acute physiology and phlebotomy blood loss predict erythrocyte transfusions in premature infants. Arch Pediatr Adolesc Med. 1997, 151 (1): 27-31. 10.1001/archpedi.1997.02170380031005.CrossRefPubMed

37.

Widness JA, Madan A, Grindeanu LA, Zimmerman MB, Wong DK, Stevenson DK: Reduction in red blood cell transfusions among preterm infants: results of a randomized trial with an in-line blood gas and chemistry monitor. Pediatrics. 2005, 115 (5): 1299-1306. 10.1542/peds.2004-1680.CrossRefPubMedPubMedCentral

38.

Shannon KM, Keith JF, Mentzer WC, Ehrenkranz RA, Brown MS, Widness JA, Gleason CA, Bifano EM, Millard DD, Davis CB, et al: Recombinant human erythropoietin stimulates erythropoiesis and reduces erythrocyte transfusions in very low birth weight preterm infants. Pediatrics. 1995, 95 (1): 1-8.PubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2431/13/176/prepub

Title: Respective effects of phlebotomy losses and erythropoietin treatment on the need for blood transfusion in very premature infants
Authors: Odile Becquet
Delphine Guyot
Philippe Kuo
Françoise Pawlotsky
Marianne Besnard
Micheline Papouin
Alexandre Lapillonne
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2013
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/1471-2431-13-176

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Respective effects of phlebotomy losses and erythropoietin treatment on the need for blood transfusion in very premature infants

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

High adiposity is associated cross-sectionally with low self-concept and body size dissatisfaction among indigenous Cree schoolchildren in Canada

Body fat percentiles of Brazilian adolescents according to age and sexual maturation: a cross-sectional study

Factors associated with physical growth of children during the first two years of life in rural and urban areas of Vietnam

Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: a retrospective longitudinal study among infants enrolled in Texas Medicaid

Hyperglycemia as a risk factor for the development of retinopathy of prematurity

Performance of the pediatric index of mortality 2 (PIM-2) in cardiac and mixed intensive care units in a tertiary children’s referral hospital in Italy