Causes of anaemia in very low birth weight infants. Phlebotomy losses are not the first accused.

AIM: The specific aim of the study was to determine the correlation between the severity of pathology, the amount of blood removed for diagnostic purposes in the 1st week of life and the incidence of early anaemia in very low birth weight (VLBW) infants. METHODS: We recorded the level of haemoglobin (Hb) and haematocrit (Ht) in each of the 50 infants entered in the study at their admission in our neonatal intensive care unit (NICU) and at the age of 8 days. We quantified for each infant the blood drawn for clinical purpose during the 1(st)week of life, using microanalytic techniques for all types of analysis performed. Using the neonatal therapeutic intensive score system (NTISS) we divided all patients into 2 groups: group A= mild light pathology; group B= severe pathology. RESULTS: There was statistically significant difference between the percent decrease of Hb and Ht with reference to the birth weight in the 2 groups. Logistic regression analysis indicated a strong correlation (P = 0.009) between higher degree of illness severity and higher percent decrease of Hb and Ht. The difference due to the amount of phlebotomy losses was not significant. CONCLUSIONS: To our knowledge, this study is the first that strongly suggest that phlebotomy losses is not the main cause of anaemia in VLBW preterm infants in the 1st week of life, when a policy of strictly attention to the amount of blood removed is performed.

Role of rHuEpo on blood transfusions in preterm infants after the fifteenth day of life.

The specific aim of the study was to assess the safety and efficacy of recombinant human erythropoietin (rHuEpo) in reducing the need for blood transfusions in preterm infants after the 15th day of life. Between 1 October 1994 and 1 October 1995, 107 preterm infants, gestational age < or = 34 weeks, were admitted to the Neonatal Intensive Care Unit and received rHuEpo subcutaneously, 900 U/kg week-1, 3 times weekly, supplemented with iron and vitamin E. Treatment was started at 8 days of life and lasted from a minimum of 6 weeks to a maximum of 3 months. A total of 116 preterm infants of the same gestational age, admitted to the Neonatal Intensive Care Unit from 1 January 1992 to 31 December 1992, served as controls. Entry criteria were gestational age < or = 34 weeks and no major congenital malformation. There were no differences in routine care between the two groups. Hematological measurements and transfusion requirements were followed during therapy. The infants were divided into two groups according to birth weight (< 1500 g and > or = 1500 g), and for each group the number of patients who received blood transfusions and when blood transfusions occurred, before or after the 15th day of life, was recorded. There was a statistically significant difference only for transfusions carried out after the 15th day of life (p < 0.002). No adverse effects attributable to rHuEpo during the treatment were noted. The results indicate that early rHuEpo treatment, in combination with iron supplements, is effective in reducing the need for blood transfusions in preterm infants after the 15th day of life.