Use of Erythropoetin in reducing blood tranfusion in Extremely Low Birth Weight neonates: A Prospective Observational study

Extremely low-birth-weight neonates (ELBW <1 Kg) comprise less than 1% of all births. Their survival rate varies between 11% to 67% in India.This increase in survival has led to an increase in blood transfusions (BT) with up to 70% requiring more than one BT. These blood transfusions increase the risk of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In ELBW infants, hemoglobin falls to levels below 7.0 to 10.0 g/dL by four to 6 weeks of life and is called ’anemia of prematurity’ (AOP), which increases the need for BT. Erythropoietin (EPO) is a glycoprotein hormone, produced by the peritubular cells of the kidney, that stimulates RBC production and plays a vital role in the pathogenesis of AOP. Low EPO levels in ELBW neonates thus provide a rationale for its use in the prevention and treatment of AOP. The Cochrane review comprised of 27 studies with 2209 infants have extensively studied the role of erythropoietin in the prevention of AOP and have concluded that early erythropoietin (< 7 days) reduced the risk of the ’use of one or more BT (typical risk ratio (RR) 0.79, 95% confidence interval (CI) 0.73 to 0.85). Further comparison of early vs late EPO and low dose ( <500 units/kg/week) vs high dose EPO (>500 units/kg/week) was analysed in the Cochrane review (6,7) and showed that the use of early and high dose EPO did not significantly reduce the ’use of one or more BT or the ’number of BT per infant" compared with late or low dose EPO administration. Most of these trials which contributed to Cochrane review were conducted in high and middle-income trials and they had non-uniformity in BT practice.  A prospective observational study from Indian sub-continent has used late and high dose EPO (600 IU weekly till discharge) and found reduction in blood transfusion rate in ELBW infants (9). There is lacunae in literature from the Indian subcontinent about the effectiveness of early and high dose EPO. Hence, we plan to conduct this study to assess the effect of erythropoietin in the prevention of >1 blood transfusion in ELBWs infant and study its effect on short term outcomes of the preterm neonate. 

We hypothesise that the use of EPO in ELBW babies will lead to a decrease in the need of blood transfusion.