Erythropoietin serum levels, versus anaemia as risk factors for severe retinopathy of prematurity

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Preterm infants with anaemia are treated with recombinant human erythropoietin (rhEPO). It is debated whether rhEPO treatment is a risk factor for retinopathy of prematurity (ROP). We evaluated longitudinal EPO and haemoglobin levels, blood transfusions and neonatal morbidities as risk factors for severe ROP.


This prospective study included 78 Swedish infants, born <28 weeks gestational age (GA), screened for ROP. We tested serum EPO levels on postnatal days 1, 7, 14 and 28 and at postmenstrual ages 32, 36 and 40 weeks. Haemoglobin levels and blood transfusions were recorded during postnatal weeks 1–4. Anaemia was defined as haemoglobin ≤110 g/L.


During postnatal week 1, infants with severe ROP requiring treatment (28%) more frequently developed anaemia (42.9% versus 8.0%, P = 0.003) and had higher mean EPO levels (postnatal day 7: 14.2 versus 10.8 mIU/mL, P = 0.003) compared to infants with no or less severe ROP not requiring treatment. In multivariable analyses, GA and anaemia during week 1 remained significant risk factors, but elevated EPO level postnatal day 7 was no longer significant.


Among infants born <28 weeks GA, anaemia during week 1 was a significant risk factor for severe ROP requiring treatment but not elevated EPO levels.

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We thank all participants, the study team led by Carola Pfeiffer-Mosesson, Anne Rosenqvist, Mary Gustafsson, Svetlana Najm, Clara Mannheimer and Anna Thurfjell for very valuable help with retrieving data for the study. This study was supported by grants provided by the Swedish Research Council (DNR# 2011-2432), Gothenburg County Council (ALFGBG-426531), De Blindas Vänner, Kronprinsessan Margaretas Arbetsnämnd för synskadade, Stiftelsen Handlanden Herman Svenssons fond för blinda och synsvaga, Carmen och Bertil Regnérs Stiftelse, Cronqvists stiftelse, NIH EY024864, EY017017, P01 HD18655, Lowy Medical Research Institute.

Authors contribution

P.L. and A.H. designed the study, participated in the acquisition, analyses and interpretation of data, drafted the article and critically revised and approved the final draft. A.P. participated in the analyses and interpretation of data, and critically revised and approved the final draft. G.H., K.S. and L.E.H.S. critically revised and approved the final draft.

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Correspondence to Pia Lundgren.

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The authors declare no competing interests.

Ethics statement:

This study was approved by the Regional Ethics Board, Gothenburg (Dnr 303-11) (Clinical trial NCT02760472).

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Lundgren, P., Hellgren, G., Pivodic, A. et al. Erythropoietin serum levels, versus anaemia as risk factors for severe retinopathy of prematurity. Pediatr Res 86, 276–282 (2019) doi:10.1038/s41390-018-0186-6

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