The current data suggest that inadequate levels of erythropoietin are an important event in the pathophysiology of the anaemia of prematurity. Clinical trials show that the use of recombinant human erythropoietin (rHu-epo) might prevent the anaemia and reduce the need for blood transfusions, although there is still no consensus about dose and schedule for administration. The objectives of this study are: (1) to asses the efficacy of rHu-epo in decrease transfusions for the of prematurity and (2) to compare two therapeutic schedules: daily use versus twice a week.

We conducted a prospective controlled randomised study in a single institution. We assigned all premature infants with gestational age ≤ 33 weeks; weight ≤ 1.550g; posnatal age 10-35 days; clinical stability as judged by the ability to tolerate enteral feedings, absence of acquired or congenital infections, minimal requirements for respiratory support and absence of seizures; absence of intraventricular haemorrhage above grade II; and no history of haemolytic anaemia. The prematures were randomised in three groups: group I, control, did not receive rHu-epo; group II received rHu-epo(EPREXR-Cilag - Biotecnologia, Br), subcutaneously, at a dose of 700 UI/kg twice a week; and group III received same dose per week every day. Supplemental oral iron (6 mg/kg/day) and vitamin E (20mg/kg/day) was ordered for all infants. Complete blood count, reticulocytes, serum ferritin, weight and height were obtained at the beginning and weekly during the study. The rHu-epo was administered until discharge, usually when 2000g of weight was reached.

We randomly assigned 37 premature infants, 13 in group I, 10 in group II and 14 in group III. These three groups had similar birth weight (mean 1.19g), posnatal age (mean 16.6 days) and all the others variables. The amount of blood samples were not different, mean 23.4 ml per infant. Reticulocyte values were higher in both treated groups (II 6,7 ± 2,2% vs III 5,5 ± 1,6% vs I 2,3 ± 0.8%), nevertheless the group III required fewer blood transfusions (III, 1 transfusion vs I, 9 vs II, 7, p=0,02) and less volume of packed erythrocytes (III 2,4 ± 6,2 ml/kg vs II 13,7 ± 21,1 vs I 10,1 ± 17,5, p=0,05). No side effects were noted.

Although these difference were not statistically significant, probably due to small sample, this study had showed a clear tendency to reduce the requirement for blood transfusions in preterms infants when were used rHu-epo at a daily schedule of 100 UI/kg. The results of group II was similar of control group. These data suggest that a stable level of erythropoietin is probably necessary to prevent the anaemia of prematurity and the best schedule should use rHu-epo more than twice a week. We are encouraging to increase the number of patients in order to achieve a statistically level of significance.