Oral Vs Subcutaneous Erythropoietin in Prevention of Anemia of Prematurity

Abstract

Introduction:  Anemia of prematurity (AOP) is a common problem of very low birth weight (VLBW) 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.  Methods: This randomized controlled study was conducted in the NICU of BSMMU from Jan-15 to Dec-15. Total 60 preterm (<34 weeks) VLBW (<1500g) infants were enrolled and randomly divided into Oral (group-A) and Subcutaneous (Group-B). Group-A received rhEPO 400 IU/Kg, 3 times weekly in oral route Group-B the same subcutaneously (S/C) and continued for 2 weeks (Total 6 doses), starting 14 days after birth, when 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: Out of 60, total 57 babies completed study, 28 vs 29 babies. Baseline clinical characteristics and hematological values were comparable in both groups. Mean Hb were 11.88±0.54gm/dl & 12.12±1.32gm/dl, the mean HCT was 35.66±1.65% & 36.38±3.97% and the mean reticulocyte 9.85±1.50% & 9.22±3.11% in the oral and subcutaneous group respectively at 12 weeks follow up (p>0.05). Similar weight gain was recorded in both groups. One neonates in each group required blood transfusion. Conclusion: Administration of oral rhEPO in preterm VLBW infants after the first two weeks of life along with iron and folic acid supplementation stimulated erythropoiesis, increased weight gains and the need for red cell transfusions similar to that of subcutaneous rhEPO.