The role of high-dose oral iron supplementation during erythropoietin therapy for anemia of prematurity

• Published in: Journal of perinatology Vol. 21; no. 4; pp. 215 - 220
• Main Authors: Bader, D, Kugelman, A, Maor-Rogin, N, Weinger-Abend, M, Hershkowitz, S, Tamir, A, Lanir, A, Attias, D, Barak, M
• Format: Journal Article
• Language: English
• Published: United States Nature Publishing Group 01.06.2001
• Subjects: Administration, Oral; Analysis of Variance; Anemia; Anemia, Neonatal - blood; Anemia, Neonatal - therapy; Birth weight; Dietary supplements; Dosage; Drug Synergism; Enterocolitis; Erythropoietin; Erythropoietin - therapeutic use; Female; Ferritin; Ferritins - blood; Gestational age; Hematocrit; Hemoglobin; Humans; Infant, Newborn; Infant, Premature, Diseases - blood; Infant, Premature, Diseases - therapy; Iron; Iron - administration & dosage; Male; Necrotizing enterocolitis; Recombinant Proteins; Reticulocytes; Therapy
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/sj.jp.7200522

To assess whether a high intake of oral iron would increase the effect of recombinant human erythropoietin (rHuEPO) on hemoglobin synthesis. We studied 30 preterm infants (gestational age 29+/-1.8 weeks, birth weight 1161+/-200 g, at age of 28+/-10 days) who were randomly assigned to receive either 8 mg/kg per day (n=15) or 16 mg/kg per day of oral iron during a course of rHuEPO therapy (900 microg/kg per week) for a duration of 4 weeks. Both groups were comparable in regard to clinical and laboratory data at the time of enrollment. rHuEPO caused a significant increase in reticulocyte count in the low- and high-dose iron groups, 17.1+/-5.3 to 34.7+/-9.2 and 16.3+/-3.3 to 42.5+/-5.6 (10(9)/l), respectively (p<0.05). However, in both groups, hematocrit values remained stable at the end of the study as compared to baseline (0.35+/-0.03% vs. 0.30+/-0.03%, 0.35+/-0.05% vs. 0.30+/-0.03%, NS) and in both groups there was a comparable and significant decrease in ferritin level (259+/-109 to 101+/-40 and 168+/-54 to 69+/-38 microg/l, respectively; p<0.01). The rates of bloody stools without any evidence of necrotizing enterocolitis were not significantly different between the two treatment groups (1/15 vs. 4/15, NS). We conclude that a higher dose (16 mg/kg per day) of oral iron is not more beneficial when compared to a lower dose (8 mg/kg per day) during rHuEPO therapy for anemia of prematurity. Further studies will define the optimal dosage and route of administration of iron supplementation during rHuEPO therapy.