Original Article

The Role of High-Dose Oral Iron Supplementation During Erythropoietin Therapy for Anemia of Prematurity

¹Department of Neonatology, "Bnai-Zion" Medical Center, B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

²Department of Neonatology, Western Galilee Medical Center, B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

³Department of Community Medicine and Epidemiology, Lady Davis Carmel Hospital, B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

⁴Department of Clinical Biochemistry, "Bnai-Zion" Medical Center, B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

⁵Department of Hematology, "Bnai-Zion" Medical Center, B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Correspondence to: D. Bader, Department of Neonatology, "Bnai-Zion" Medical Center, 47 Golomb Street, Haifa 31048, Israel

Abstract

OBJECTIVE:To assess whether a high intake of oral iron would increase the effect of recombinant human erythropoietin (rHuEPO) on hemoglobin synthesis.

METHODS: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 g/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.

RESULTS: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 (10⁹/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 g/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).

CONCLUSION: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.

Journal of Perinatology (2001) 21, 215-220

Received 5 July 2000; accepted 28 December 2000

June 2001, Volume 21, Number 4, Pages 215-220

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