Aim: To investigate whether 1500 IU/kg/week erythropoietin(rhEPO) reduce transfusion need in infants < 1000 g more effectively than 750 IU/kg/week.

Study design: In a randomized double blind multicentre trial, 184 infants with birthweights 500 to 999 g were treated with rhEPO either 750 or 1500 IU/kg/week from day 3 of life until completion of 37 weeks of gestation. Oral iron supplementation started on day 3 and increased from 3 to 9 mg/kg/day.

Results: The failure free rate (= no transfusion and hematocrit never below 0.30 I/I) was 28% in the low-dose and 30% in the high dose group(n.s.). It was inversely related with birthweight, gestational age, and baseline hematocrit, and was almost zero in ventilated infants. Median hematocrit decrease was less pronounced (P = 0.048) in the high dose group (- 0.07 I/I versus - 0.10 I/I). Course of hemoglobin, neutrophils, platelets, serum iron, and transferrin saturation did not differ significantly between the two groups.

Conclusion: Increasing the rhEPO dose from 750 to 1500 IU/kg/week is not justified to prevent anemia in preterm infants < 1000 g.