Randomized trial of early erythropoietin supplementation after preterm birth: Iron metabolism and outcome

Background: Excess of iron and oxidant injury shortly after birth may be associated with neonatal morbidities in preterm infants. Aims: The aim was to determine whether administration of erythropoietin without iron supplementation decreases iron load and morbidity. Study design and subjects: In a randomized trial, we administered erythropoietin (EPO 250 IU/kg daily during the first 6 days of life) or placebo to 39 preterm infants (BW 700-1500 g, GA <= 30.0 weeks). Outcome measures: The iron status, postnatal morbidities and follow-up at the age of two years were investigated. Results: In all, 21 EPO- and 18 placebo-treated infants were recruited. A requirement of red blood cell transfusions during first 28 days was similar between the study groups. EPO treatment decreased total serum iron concentration (p = 0.035). EPO supplementation had no significant effect on serum transferrin receptors or reactive non-protein-bound iron. There were no differences in neonatal morbidity or in survival without major neurological abnormality at two years of age. Conclusions: A 6-day course of EPO decreased the iron load in preterm infants. There was no change in reactive, non -protein bound iron plasma levels and no influence on the outcomes during early childhood. Whether the neurocognitive effects of early EPO treatment can be detectable later in childhood remained to be verified.