Effect of Oral Erythropoietin in Prevention of Anemia of Prematurity

Introduction: Anemia of prematurity (AOP) is a common problem of very low birth weight babies. Blood transfusion is a necessity when it occurs in moderate to severe form putting the child in to the risk of transfusion related complications. Erythropoietin, a potent stimulator of hemopoesis is available in breast milk in good amount and absorbed intact under physiologic condition. In this background oral recombinant human erythropoietin (rhEPO) can be a useful alternative to its subcutaneous administration in prevention of AOP.Objective: To evaluate the efficacy of oral rhEPO in the prevention of AOP in very low birth weight (VLBW) neonates.Methods: This randomized controlled study conducted in the NICU of BSMMU over one year. Total 60 preterm (<34 weeks)VLBW (<1500g) infants were enrolled and randomly divided into Control (group-I), Oral (group-II) and Subcutaneous (group III). Experimental groups (group-II & group-III) received rhEPO 400 IU/Kg, 3 times weekly in oral and subcutaneous (S/C) route respectively and continued for 2 weeks (Total 6 doses). Therapy was initiated 14 days after birth when the baby achieved oral feeding of at least 50 ml/kg/day of breast milk. All infants received oral iron and folic acid supplementation up to 12 weeks of postnatal age. Transfusion data were recorded. Anthropometric and hematological assessments were done at 2, 4, 6 and 12 weeks of age.Results: Baseline clinical characteristics and hematological values were almost similar in all groups. Mean hemoglobin were 11.34±0.68gm/dl, 11.88±0.54gm/dl& 12.12±1.32 gm/dl, the mean hematocrit were 34.11±2.03%, 35.66±1.65% & 36.38±3.97% and the mean reticulocyte were 7.56±2.48%, 9.85±1.50% & 9.22±3.11% in the control, oral and subcutaneous group respectively and the differences are statistically significant (p<0.05).Weight gain was higher in the intervention group at 6 and 12 weeks follow up than the control group(p<0.05).Only 2 (5.25%) infants, one in each of the intervention groups required blood transfusion, compared to 6 (31.5%) infants in control group (p<0.01).Conclusion: Oral EPO is as good as subcutaneous use of EPO in stimulating erythropoesis, maintaining HCT and Hb at high level and is safe in preterm baby.Bangladesh J Child Health 2017; VOL 41 (2) :101-109

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Blood Transfusion and Breast Milk Transmission of Cytomegalovirus in Very Low-Birth-Weight Infants

JAMA Pediatrics ◽

10.1001/jamapediatrics.2014.1360 ◽

2014 ◽

Vol 168 (11) ◽

pp. 1054 ◽

Cited By ~ 84

Author(s):

Cassandra D. Josephson ◽

Angela M. Caliendo ◽

Kirk A. Easley ◽

Andrea Knezevic ◽

Neeta Shenvi ◽

...

Keyword(s):

Birth Weight ◽

Breast Milk ◽

Blood Transfusion ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Low Birth Weight Infants ◽

Breast Milk Transmission

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HUMAN BREAST MILK FORTIFICATION WITH SKIMMED MILK AND OLIVE OIL FOR WEIGHT GAIN IN VERY LOW BIRTH WEIGHT NEONATES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i3.4282 ◽

2021 ◽

Vol 71 (3) ◽

pp. 1080-84

Author(s):

Arouj Waqqas ◽

Zeeshan Ahmed ◽

Huma Farrukh ◽

Hina Khalid ◽

Talal Waqar

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Breast Milk ◽

Low Birth Weight ◽

Hospital Stay ◽

Olive Oil ◽

Very Low Birth Weight ◽

Control Group ◽

Human Breast Milk ◽

Skimmed Milk

Objective: To observe the effect of fortification of expressed human breast milk with olive oil and skimmed milk in improving weight gain in very low birth weight neonates and shortening their length of hospital stay. Study Design: A comparative prospective study. Place and Duration of Study: Combined Military Hospital Lahore, from Mar 2018 to Mar 2019. Methodology: Neonates admitted with very low birth weight and gestational age of <34 weeks were included in study. Sixty babies were enrolled using non-probability consecutive sampling; random number table used to allocate them into a fortifycation group and a control group. The control group received expressed milk alone, while olive oil oneml twice daily and skimmed milk one gram in every third feed were added to expressed milk in the fortification group. Results: The study comprised of 60 neonates, with 30 in each of the groups. Weight gain was 24.83 ± 5.63 in the fortification group and 11.72 ± 3.95 in the control group (p≤0.001). Mean hospital stay was 20.57  16.511 in the fortification group and 27.67 ± 8.89 in the control group (p≤0.043). Conclusion: Olive oil and skimmed milk fortification of breast milk was effective for weight gain and reducing length of hospital stay in very low birth weight neonates.

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Serum triglycerides of breast milk fed very low birth weight infants

Clinical Biochemistry ◽

10.1016/0009-9120(95)91346-5 ◽

1995 ◽

Vol 28 (3) ◽

pp. 323-324

Author(s):

T.R. Fenton ◽

N. Singhal ◽

R.D. Baynton ◽

A.R. Akierman

Keyword(s):

Birth Weight ◽

Breast Milk ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Low Birth Weight Infants ◽

Serum Triglycerides

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Retrolental Fibroplasia and Blood Transfusion in Very Low-Birth-Weight Infants

PEDIATRICS ◽

10.1542/peds.68.6.770 ◽

1981 ◽

Vol 68 (6) ◽

pp. 770-774 ◽

Cited By ~ 1

Author(s):

Linda M. Sacks ◽

David B. Schaffer ◽

Endla K. Anday ◽

George J. Peckham ◽

Maria Delivoria-Papadopoulos

Keyword(s):

Birth Weight ◽

Blood Transfusion ◽

Low Birth Weight ◽

Red Blood Cells ◽

Blood Cells ◽

Very Low Birth Weight ◽

Statistical Significance ◽

Low Birth Weight Infants ◽

Retrolental Fibroplasia ◽

Packed Red Blood Cells

The relative contribution of transfusions of adult blood to the development of retrolental fibroplasia (RLF) in very low-birth-weight infants was examined. Five years of experience with the expanded use of replacement and exchange transfusions in 90 infants with birth weight ≤1,250 gm was reviewed. Twenty percent of the infants developed cicatricial RLF. Exchange transfusion was not related to development of cicatricial RLF. The incidence of RLF in infants receiving ≥130 ml of packed red blood cells per kilogram of birth weight as replacement blood transfusion (RBT) was significantly higher (42.9%) than that in infants receiving 61 to 131 ml of packed red blood cells per kilogram (15.4%) and infants receiving ≤60 ml of packed red blood cells per kilogram (0%), P < .001. The need for RBT, however, was strongly correlated (r = .85, P < .001) with increasing duration of O2 therapy. When O2 therapy was controlled for, the association between RBT and RLF did not achieve statistical significance (P = .07). The association between RBT and RLF remained significant when adjusted for duration of therapy in fractional inspired oxygen (FIO2) >0.4. Further detailed studies of large numbers of susceptible infants are warranted to assess the magnitude of the contribution of transfusions of adult blood to development of RLF.

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Fat Emulsion Tolerance in Very Low Birth Weight Neonates: Effect on Diffusion of Oxygen in the Lungs and on Blood pH

PEDIATRICS ◽

10.1542/peds.78.1.79 ◽

1986 ◽

Vol 78 (1) ◽

pp. 79-84 ◽

Cited By ~ 1

Author(s):

Yves W. Brans ◽

Elizabeth B. Dutton ◽

Donna S. Andrew ◽

Elizabeth M. Menchaca ◽

Donna L. West

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Oxygen Diffusion ◽

Very Low Birth Weight ◽

Fat Emulsion ◽

Group Iii ◽

Blood Ph ◽

Constant Rate ◽

Appropriate For Gestational Age ◽

Fat Infusion

Forty-one very low birth weight neonates (820 to 1,510 g and 27 to 34 weeks of gestation) requiring total parenteral nutrition were randomly assigned to one of three regimens of administration of fat emulsion for a period of eight days. Groups I and II received the emulsion at a constant rate for, respectively, 24 and 16 hours, beginning with a daily dosage of 1 g/kg and increasing daily by 1 g/kg to a maximum of 4 g/kg. Group III received the emulsion at a constant rate or 4 g/kg for 24 hours. Blood pH and alveolar-arteriolar gradient of oxygen diffusion in the lungs were measured at regular intervals. The various regimens and rates of fat infusion appeared to have no deleterious effect on blood pH and alveolar-arteriolar oxygen diffusion gradient. Infusion rates as used in the study for appropriate for gestational age very low birth weight neonates appear to be safe, although caution is always warranted when dealing with tiny neonates whose pulmonary reserve is minimal. In view of data from other studies, it is suggested to infuse fat at a constant rate for 24 hours to avoid overloading the clearance mechanisms of fat particles from plasma.

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High Blood Pressure during Pregnancy is not a Protective Factor for Preterm Infants with Very Low Birth Weight. A Case-Control Study

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0037-1601883 ◽

2017 ◽

Vol 39 (04) ◽

pp. 155-161 ◽

Cited By ~ 1

Author(s):

Annibal Sabino ◽

Eduardo de Souza ◽

Ana Goulart ◽

Adriana Lima ◽

Nelson Sass

Keyword(s):

Blood Pressure ◽

Birth Weight ◽

Low Birth Weight ◽

Protective Factor ◽

Case Control Study ◽

Very Low Birth Weight ◽

Case Control ◽

World Health ◽

Control Group ◽

Control Study

Objective To evaluate whether the presence of maternal blood pressure reduces the risks of morbidity, perinatal mortality and morbidity at 24 months of age in very low birth weight infants (VLBWIs) compared with a control group. Methods A retrospective, observational, case-control study. Total 49 VLBWIs were allocated to the study group, called the maternal arterial hypertension group (AHG), and matched with 44 in the control group (CG). The infants were assessed during hospitalization and at 12 and 24 months corrected age at a specialized clinic. For the assessment of growth, the World Health Organization (WHO) Anthro software (Geneva, 2006) was used, and for the psychomotor assessment, the Denver II test was used. Results In relation to the antenatal variables, the infants of the AHG had more centralized circulation assessed by Doppler, received more corticosteroids and magnesium sulfate, and were born by cesarean section more frequently. In terms of the postnatal and in-hospital outcomes, the AHG had a higher gestational age at birth (30.7 versus 29.6 weeks) and a lower frequency of 5-minute Apgar scores of less than 7 (26.5% versus 52.3%). The CG had a higher rate of pulmonary dysplasia (30.2% versus 8.3%). There were no differences in terms of hospital mortality, complications, somatic growth and functional problems at 24 months of corrected age. Conclusion The presence of maternal hypertension, especially preeclampsia, was not a protective factor against morbidity, mortality and evolution in VLBWIs aged up to 24 months. Therefore, the clinical practice should be focused on prolonging the pregnancy for as long as possible in these conditions as well.

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Sequence analyses of variable cytomegalovirus genes for distinction between breast milk- and transfusion-transmitted infections in very-low-birth-weight infants

Transfusion ◽

10.1111/trf.14920 ◽

2018 ◽

Vol 58 (12) ◽

pp. 2894-2902 ◽

Cited By ~ 4

Author(s):

Yasumi Furui ◽

Naoji Yamagishi ◽

Ichiro Morioka ◽

Rikizo Taira ◽

Kosuke Nishida ◽

...

Keyword(s):

Birth Weight ◽

Breast Milk ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Sequence Analyses ◽

Low Birth Weight Infants

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Effect of short term recombinant human erythropoietin (rHuEPO) therapy in the prevention of anemia of prematurity (AOP) in very low birth weight (VLBW) neonates

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v38i3.14340 ◽

2013 ◽

Vol 38 (3) ◽

pp. 119-123 ◽

Cited By ~ 6

Author(s):

BHN Yasmeen ◽

MAKA Chowdhury ◽

MM Hoque ◽

MM Hossain ◽

R Jahan ◽

...

Keyword(s):

Folic Acid ◽

Birth Weight ◽

Low Birth Weight ◽

Recombinant Human Erythropoietin ◽

Very Low Birth Weight ◽

Controlled Trial ◽

Control Group ◽

Short Term ◽

Human Erythropoietin ◽

Anaemia Of Prematurity

Premature infants especially those with birth weight <1500 g suffer from Anaemia of prematurity (AOP) and associated problems. Erythropoietin therapy is a safe effective way to prevent and to treat anaemia of prematurity. To evaluate the effect of short term administration of recombinant human erythropoietin (rHuEPO) with iron and folic acid in very low birth weight (VLBW) neonates in the prevention of anaemia of prematurity. A randomized controlled trial was carried out at Dhaka Shishu Hospital. Sixty preterm very low birth weight (PTVLBW) babies were enrolled in this study. Thirty were assigned to rHuEPO group and 30 as control. Baseline haematologic values were estimated before administration of rHuEPO. From day 7 of life rHuEPO-200 IU/kg/dose subcutaneously every alternate day for 2 weeks was administered to rHuEPO group. All infants in both groups have received oral iron, folic acid from day 14. Clinical and haematological assessment was done at 6 and 10 weeks of life. Baseline clinical characteristics and haematologic values were almost similar in both groups. This study has shown increase in haematological values(haemoglobin and haematocrit) and reduction in the number of blood transfusions during both the 1st and 2nd follow up in rHuEPO group in comparison to control group (p<0.01). Short term rHuEPO appears to be very effective in prevention of Anaemia of prematurity. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14340 Bangladesh Med Res Counc Bull 2012; 38(3): 119-123 (December)

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Neurodevelopmental Outcome at 36 Months' Corrected Age of Preterm Infants in the Multicenter Indomethacin Intraventricular Hemorrhage Prevention Trial

PEDIATRICS ◽

10.1542/peds.98.4.714 ◽

1996 ◽

Vol 98 (4) ◽

pp. 714-718 ◽

Cited By ~ 5

Author(s):

Laura R. Ment ◽

Betty Vohr ◽

William Oh ◽

David T. Scott ◽

Walter C. Allan ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Intraventricular Hemorrhage ◽

Maternal Education ◽

Low Dose ◽

Very Low Birth Weight ◽

Cranial Ultrasound ◽

The Mean ◽

English Monolingual

Objectives. Low-dose indomethacin has been shown to prevent intraventricular hemorrhage (IVH) in very low birth weight neonates, and long-term neurodevelomental follow-up data are needed to validate this intervention. We hypothesized that the early administration of low-dose indomethacin would not be associated with adverse cognitive outcome at 36 months' corrected age (CA). Methods. We enrolled 431 neonates of 600 to 1250 g birth weight with no IVH at 6 to 12 hours in a randomized, prospective trial to determine whether low-dose indomethacin would prevent IVH. A priori, neurodevelopmental follow-up examinations, including the Stanford-Binet Intelligence Scale and Peabody Picture Vocabulary Test-Revised, and standard neurologic examinations were planned at 36 months' CA. Results. Three hundred eighty-four of the 431 infants survived (192 [92%] of 209 infants receiving indomethacin versus 192 [86%] of 222 infants receiving saline), and 343 (89%) children were examined at 36 months' CA. Thirteen (8%) of the 166 infants who received indomethacin and 14 (8%) of 167 infants receiving the placebo were found to have cerebral palsy. There were no differences in the incidence of deafness or blindness between the two groups. For the 248 English-monolingual children for whom IQ data follow, the mean gestational age was significantly younger for the infants who received indomethacin than for those who received the placebo. None of the 115 infants who received indomethacin was found to have ventriculomegaly on cranial ultrasound at term, compared with 5 of 110 infants who received the placebo. The mean ± SD Stanford-Binet IQ score for the 126 English-monolingual children who had received indomethacin was 89.6 ± 18.92, compared with 85.0 ± 20.79 for the 122 English-monolingual children who had received the placebo. Although maternal education was strongly correlated with Stanford-Binet IQ at 36 months' CA, there was no difference in educational levels between mothers of the infants receiving indomethacin and the placebo. Conclusions. Indomethacin administered at 6 to 12 hours as prophylaxis against IVH in very low birth weight infants does not result in adverse cognitive or motor outcomes at 36 months' CA.

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