Abstract
Background/Aim: The optimal management of anaemia of prematurity is still unknown. Therapeutic approaches include delayed cord clamping and early treatment with protein and iron supplements and prophylactic rh Epo. We investigated the possible benefit of delayed cord clamping (45 s) combined with rh Epo 750 IU/kg/week from day 8–10 with early cord clamping and rh Epo.
Methods: Prospective randomised pilot study in preterm infants <33 weeks gestation. Exclusion criteria: Rh-incompatibility, fetal hydrops, congenital malformations and chromosomal anomalies. In the control group I cord clamping time was „T 20 s and standard protein and iron supplements (2 mg/kg/d) were started on day 28. In group II cord clamping time and protein supplements were the same, but additionally rh Epo 750 IU/kg/week from day 8 °V 10 and Fe-II (6 °V 12 mg/kg/d) from day 14 were given. In group III delayed cord clamping time was 45 s, rh Epo and nutritional supplements were given as in group II. Packed red cell (PRC) transfusions were given according to a strict protocol. Gestational age, birth weight, haemoglobin (Hb), iatrogenic blood loss and frequency and volume of PRC transfusions until day 42 were recorded. The study was approved by the ethics committee of the WWU Münster. Parental consent was obtained prior to delivery. Statistical analysis was performed with a standard ANOVA package.
Results: The table gives the mean haemoglobin values for all groups until the first PRC transfusion was given (Hb until first transfusion, p < 0.05 at day 14). Gestational age (group I 30 weeks, group II 29 weeks, group III 30 weeks), birth weight (group I 1152 g, group II 1216 g, group III 1461 g) and iatrogenic blood loss did not differ significantly. No PRC transfusions were given in group II and III, whereas 9/14 (64 %) in group I were transfused (p < 0.01, ANOVA). After 14 days the Hb was significantly higher in group III than in group I and II (p < 0.05, ANOVA).
Conclusions: To our knowledge this is the first report on the combination of delayed cord clamping of 45 s and rh Epo. In comparison to the control group transfusion requirements were significantly reduced. Delayed cord clamping has helped effectively to sustain the Hb for two weeks in order to cover the well-known delayed onset of rh Epo therapy.
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Alvarez, J., Hoedemaker, N., Huelskamp, G. et al. 83 Pilotstudy: Combination of Delayed Cord Clamping and Recombinant Erythropoietin (Rhepo) for The Prevention of Anaemia of Prematurity. Pediatr Res 56, 478 (2004). https://doi.org/10.1203/00006450-200409000-00106
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DOI: https://doi.org/10.1203/00006450-200409000-00106