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

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 μg/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 (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 μg/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.