[Blood transfusion despite early use of erythropoietin: failure or limit of therapy? Annual cohort study of premature infants weighing less than 1500 g].

STUDY: Prospective, observative study.

SETTING

Neonatal intensive care unit in a university tertiary care hospital.

AIMS: 1) Assessment of blood transfusion requirement. 2) Demonstration of haematocrit and hemoglobin level difference at birth between transfused and non-transfused infants. 3) Assessment of iron mass before and after early iron supplementation.

POPULATION: All premature infants without cardiopathy, surgical diseases, hemolysis or haemorrhage, at less than 30 weeks of gestational age or less than 32 weeks, weighing less than 1,500 grams, with respiratory distress syndrome admitted into the unit during the year 1998, were included in the study. Each received erythropoietin (750 U.kg-1.wk-1) with intravenous iron supplements from day 5 (0.017 mmol.kg-1.d-1), then orally (0.17 mmol.kg-1.d-1).

RESULTS

Seventy-nine premature infants were included in this study. 1) Sixty-seven percent of the transfusions occurred during the first 14 days of life. 2) Haematocrit and hemoglobin levels at birth were significantly different between transfused and non-transfused infants (P < 0.001) and remained different for infants of less than 28 weeks (P < 0.01). 3) After six weeks of iron supplementation (mean 0.31 mmol/kg), the ferritin level had significantly decreased in the non-transfused (P < 0.001) and transfused population (P < 0.01).

CONCLUSION

Increasing the haematocrit and the hemoglobin levels at birth, for example by placentofetal transfusion, could decrease the number of early transfusion. Early intravenous iron supplementation had no side effects but did not maintain iron levels.