336 - Effects of Late Erythropoietin (EPO) Administration in Preterm Infants with Birth Weight ≤ 1,250 grams

Poster Number: 336
Publication Number: 336.122

Cherry Uy, University of California, Irvine, School of Medicine, Orange, CA, United States; Alison Chen, University of California, Irvine, School of Medicine, Monrovia, CA, United States; Alyssa Le, UCI Health, Orange, CA, United States; Fayez M. Bany-Mohammed, UC Irvine Medical Center, Orange, CA, United States; Benjamin Lee, University of California, Irvine, School of Medicine, Orange, CA, United States

Background: Preterm infants are at risk of developing anemia due to phlebotomy losses and inherent low plasma levels of circulating EPO. Current data shows that late administration of EPO reduces the number of  RBC transfusions. However, data on safety and efficacy in preterm infants remains to be a subject of clinical investigation and discussions. 

Objective: The purpose of this study is to determine the efficacy and safety of late administration of EPO in decreasing RBC transfusions and donor exposure.

Design/Methods: Single-center retrospective review comparing preterm infants with BW ≤1,250g who received late EPO (1,200 u/kg/wk >3w of life) vs no EPO (control arm) for study period 2015-2019. Infants with congenital anomalies, thromboembolic disease, hypertension, or seizures were excluded. Primary outcomes were: number of late blood transfusions, total volume transfused, number of donor exposure and hemoglobin prior to discharge. Secondary outcomes include incidence of ROP, IVH, NEC and BPD. Student's t test, Wilcoxon rank sum test, Chi-square, or Fisher's exact test were used where appropriate.

Results: Two hundred and thirty-five infants were included (103 in EPO arm vs 132 in control). Infants who received EPO were of smaller birth weight (g) and had lower Hgb at 3w of life (g/L) (920 [700-1065] vs 985 [783-1120], p=0.08; 11.9 [9.6-11.9] vs 12.9 [10.2-12.9], p = 0.009). The percentage of infants requiring late blood transfusions were similar in both arms (36.9% in EPO vs 28.8% in control arm, p=0.19). The number of late transfusions per patient was significantly lower in EPO vs control (1.55 ± 1.11 vs 3,58 ± 2.46, p< 0.001). Total transfusion volume/patient (mL/kg) and number of donors/patient were significantly less in EPO vs control arm (50.49 ± 37.12 vs 84.22 ± 66.20, p=0.002; 1.2 ± 0.6 vs 1.5 ± 0.9, p=0.013). Despite having a lower Hgb at 3w of age, Hgb (g/dL) prior to discharge was significantly higher in the EPO group (11.7 ± 1.5 vs 11.1 ± 1.5, p < 0.001). No statistically significant difference in the incidence of NEC, severe IVH, severe ROP and BPD between the two arms were observed (p >0.05).Conclusion(s): Late administration of EPO in preterm infants with birth weight ≤ 1,250 grams reduces the number of late transfusions, total transfusion volume, and donor exposure.