Anemia of prematurity medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asra Firdous, M.B.B.S.[2]

Overview

Medical therapy

Patients with no symptoms, stable vital signs, and adequate nutrition require no treatment
Close monitoring and supportive care are the preferred management in asymptomatic infants with anemia of prematurity
Measures should be taken to maintain adequate levels of vitamin E, vitamin B12, vitamin B6, and iron
Regular checking of hematocrit is essential in infants with anemia of prematurity until a steady increase in the hematocrit levels has been achieved

Erythropoietin (EPO) helps in preventing anemia of prematurity in preterm and low birth weight infants
Recombinant human erythropoietin is used in premature infants to decrease the number of complications associated with the transfusion therapy
The preferred route of administration is the subcutaneous route
The preferred regimen is 400U/kg/dose through the subcutaneous route (SC) 3 times a week or 200U/kg/dose through the intravenous (IV) route daily
Preterm infants respond well to erythropoietin (EPO) therapy with reticulocytosis
Iron and folic acid supplementation is essential
The preferred regimen for iron supplementation is 6-8 mg/kg/day orally or 1 mg/kg IV of iron sucrose or iron dextran
Regular monitoring of serum iron levels should be done using serum ferritin or zinc protoporphyrin to heme ratio, monthly or bimonthly
Although no adverse effects have been documented in the newborns, erythropoietin therapy is not universally accepted as the standard therapy for infants with anemia of prematurity
Alternatively, Darbepoietin alfa can also be used

Complications associated with erythropoietin therapy are minimal in preterm infants. Following complications have been documented in adult patients treated with recombinant erythropoietin therapy.

Transfusion therapy is the mainstay in the treatment of anemia of prematurity
Frequency of transfusions depends on the gestational age and severity of symptoms
A transient decrease in erythropoiesis and erythropoietin levels occur after the blood transfusion
PRBC transfusion results in an increase in systemic oxygen transport and decrease in lactic acid levels, cardiac output, and fractional oxygen extraction
Transfusion guidelines that should be followed in infants with anemia of prematurity are
- 15-20 mg/kg of PRBC transfused over 3-4 hours
- Irradiated, CMV negative, leukocyte depleted, hemoglobin S negative, typed and screened PRBC should be used for transfusion
- Infants with anemia of prematurity are given blood transfusion if:
  - Hematocrit is less than 35% in first week after birth and infant is unstable
  - Hematocrit is less than 28% in first week after birth or infant is unstable
  - Hematocrit is less than 20% after one week of birth

References

Overview