Human Recombinant Erythropoietin in the Prevention and Treatment of Anemia of Prematurity
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Pediatr Drugs 2002; 4 (2): 111-121 1174-5878/02/0002-0111/$25.00/0 © Adis International Limited. All rights reserved.
Human Recombinant Erythropoietin in the Prevention and Treatment of Anemia of Prematurity Robin K. Ohls Division of Neonatology, University of New Mexico, Albuquerque, New Mexico, USA
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Fetal Erythropoiesis . . . . . . . . . . . . . . . . . . . . . 2. Physiological Anemia in Term and Preterm Neonates . 3. Human Recombinant Erythropoietin Pharmacokinetics 4. Clinical Studies . . . . . . . . . . . . . . . . . . . . . . . 5. Iron Administration . . . . . . . . . . . . . . . . . . . . . 6. Vitamin E, Folate, and Other Nutritional Factors . . . . 7. Adverse Effects . . . . . . . . . . . . . . . . . . . . . . . 8. Transfusion Practices in Neonates . . . . . . . . . . . . . 9. Conclusions and Future Considerations . . . . . . . . .
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Human recombinant erythropoietin has been studied extensively as treatment for a variety of anemias. Since in vitro studies showed the primary etiology of the anemia of prematurity to be insufficient serum erythropoietin concentrations, clinical trials have evaluated the administration of human recombinant erythropoietin to preterm infants to treat this indication. These studies were followed by pharmacokinetic determinations in animal models and preterm infants, which revealed that preterm infants required greater doses of human recombinant erythropoietin because of a more rapid clearance and greater volume of distribution. Recent studies have focused on the administration of human recombinant erythropoietin in the first weeks of life to alleviate the anemia caused by excessive phlebotomy losses, and to prevent the anemia of prematurity. In addition, human recombinant erythropoietin has been tried clinically in a variety of neonatal populations in an attempt to decrease or eliminate transfusions. Although much information has been accumulated about the clinical use of human recombinant erythropoietin in preterm infants over the last 15 years, many questions remain unanswered. The evolution
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