ABSTRACT
OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.
Subject(s)
Anemia, Neonatal/drug therapy , Anemia, Neonatal/epidemiology , Iron Deficiencies , Medication Adherence/statistics & numerical data , Micronutrients/administration & dosage , Vitamin A Deficiency/epidemiology , Zinc/deficiency , Age Factors , Anemia, Iron-Deficiency/epidemiology , Brazil/epidemiology , Dietary Supplements/statistics & numerical data , Female , Humans , Infant , Infant, Premature , Iron/blood , Male , Prevalence , Prospective Studies , Reference Values , Regression Analysis , Risk Factors , Socioeconomic Factors , Statistics, Nonparametric , Time Factors , Treatment Outcome , Vitamin A Deficiency/blood , Zinc/bloodABSTRACT
OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.
Subject(s)
Humans , Male , Female , Infant , Anemia, Neonatal/drug therapy , Anemia, Neonatal/epidemiology , Iron/deficiency , Medication Adherence/statistics & numerical data , Micronutrients/administration & dosage , Vitamin A Deficiency/epidemiology , Zinc/deficiency , Age Factors , Anemia, Iron-Deficiency/epidemiology , Brazil/epidemiology , Dietary Supplements/statistics & numerical data , Infant, Premature , Iron/blood , Prevalence , Prospective Studies , Reference Values , Regression Analysis , Risk Factors , Socioeconomic Factors , Statistics, Nonparametric , Time Factors , Treatment Outcome , Vitamin A Deficiency/blood , Zinc/bloodABSTRACT
Introducción: la eritropoyetina alfa recombinante forma parte del tratamiento de la anemia de la prematuridad. En Cuba su uso ha sido limitado y controvertido en cuanto a esquema y dosis empleada. Métodos: ensayo clínico prospectivo, multicéntrico, no aleatorizado, de eficacia y seguridad de eritropoyetina en la disminución de transfusiones en el recién nacido pretérmino de muy bajo peso. Se incluyeron 72 neonatos con edad gestacional menor de 34 semanas posmenstruales, y peso al nacer menor o igual a 1 500 g, con más de 7 días posnatales e ingesta de 50 mL/kg/día. Resultados: todos recibieron eritropoyetina 300 U/kg, subcutánea, 3 veces/semana, hasta las 40 semanas de edad gestacional y suplemento de hierro y vitaminas. La eritropoyetina fue muy segura, solo se notificó con relación posible una retinopatía de la prematuridad, ligera y recuperada. Conclusiones: se transfundieron 7 pacientes (9,7 por ciento) en el curso del estudio. El uso tardío de eritropoyetina en el pretérmino de muy bajo peso confirma su eficacia y seguridad
Introduction: recombinant alpha erythropoietin is part of the treatment for anemia of prematurity. The use of this one in Cuba has been restricted and controversial as to schedule and dose. Methods: prospective, non-randomized multicenter assay on the safety and efficacy of erythropoietin in the reduction of blood transfusion in very-low-weight preterm newborn. Seventy two neonates with gestational age under 34 post-menstruation weeks, weighing equal or less than 1 500 g, over 7 days of life after birth and fed on 50 mL/kg/day were included in the study. Results: all of them received 300 U/kg erythropoietin by subcutaneous administration three times a week up to reaching 40 weeks of gestational age and an iron and vitamin supplement. Erythropoietin is very safe; it was just possibly related to slight retinopathy of prematurity, but overcome. Conclusions: seven patients were transfused (9.7 percent ) in the course of study. The late use of erythropoietin in very-low-weight preterm child confirms its efficacy and safety
Subject(s)
Humans , Male , Female , Infant, Newborn , Anemia, Neonatal/prevention & control , Anemia, Neonatal/drug therapy , Erythropoietin/therapeutic use , Infant, Premature/blood , Multicenter Studies as Topic , Prospective StudiesABSTRACT
OBJECTIVE: To compare reticulocyte responses of once-per-week erythropoietin (EPO) dosing with 3-times-a-week dosing in preterm infants. STUDY DESIGN: Infants weighing ≤ 1500 g and ≥ 7 days of age were randomized to once-per-week EPO, 1200 U/kg/dose, or 3-times-a-week EPO, 400 U/kg/dose, subcutaneously for 4 weeks, along with iron and vitamin supplementation. Complete blood counts, absolute reticulocyte counts (ARCs), transfusions, phlebotomy losses, and adverse events were recorded. RESULTS: Twenty preterm infants (962 ± 55 g, 27.9 ± 0.4 weeks, 17 ± 3 days of age) were enrolled. Groups were similar at baseline. Infants in both groups had increased ARCs, which were similar between treatment groups at the start and end of 4 weeks. Hematocrit remained stable, and similar numbers of transfusions were administered. No adverse effects of either dosing schedule were noted. CONCLUSIONS: Preterm infants respond to weekly EPO by increasing ARCs and maintaining hematocrit. We speculate that once-per-week EPO dosing might be beneficial to preterm infants requiring increased erythropoiesis.
Subject(s)
Anemia, Neonatal/drug therapy , Erythropoiesis/drug effects , Erythropoietin/administration & dosage , Infant, Premature , Infant, Very Low Birth Weight/blood , Anemia, Neonatal/diagnosis , Blood Cell Count , Cross-Over Studies , Dose-Response Relationship, Drug , Drug Administration Schedule , Erythrocyte Count , Female , Follow-Up Studies , Hematocrit , Humans , Infant, Newborn , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/drug therapy , Injections, Subcutaneous , Intensive Care Units, Neonatal , Iron Compounds/administration & dosage , Male , Pilot Projects , Risk Assessment , Severity of Illness Index , Treatment Outcome , Vitamins/administration & dosageABSTRACT
Hematopoietic and non-hematopoietic effects of recombinant erythropoietin (Epo) given to preterm infants are controversially discussed. Because renal loss of Epo was significantly higher after intravenous versus subcutaneous Epoetin-beta administration, we suggest a reconsideration of whether subcutaneous recombinant Epo is more efficient and safer because of lower peaks of circulating Epo.
Subject(s)
Anemia, Neonatal/drug therapy , Anemia, Neonatal/urine , Erythropoietin/administration & dosage , Erythropoietin/pharmacokinetics , Infant, Premature, Diseases/drug therapy , Infant, Premature, Diseases/urine , Humans , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Injections, Intravenous , Injections, Subcutaneous , Longitudinal Studies , Recombinant ProteinsABSTRACT
Recombinant human erythropoietin (rHuEpo) has become the most widely used cytokine in the world. Following the success of its use in patients with end-stage renal disease, the usefulness of rHuEpo to ameliorate other anemias was assessed, including pediatric patients and newborn infants. The treatment or prevention of anemia of prematurity with rHuEpo resulted in a significant reduction in the number of transfusions and donor exposure. A clear definition of which premature babies must receive therapy needs yet to be established. Other indications in neonatal period include hyporegenerative and hemolytic anemias. With the exception of chronic renal failure, in older children the efficacy of rHuEpo has not been evaluated as in adults. While an impressive amount of studies were carried out during the last years in adult patients with cancer-related or HIV-infection-related anemias, allowing to establish clear conclusions on its efficacy, only a few trials with small number of patients have been reported in children. Up to date, results in pediatric patients suggest that rHuEpo therapy is as useful as in adult patients, but prospective, randomized trials including large number of patients are essential to achieve definitive conclusions. Results of studies designed to evaluate the efficacy of rHuEpo for sustaining an adequate dose of ribavirin in patients receiving treatment for hepatitis C are encouraging. The potential for use of the non-hematopoietic effects of rHuEpo in newborn infants is a novel and exciting issue. The role of rHuEpo as a tissue protective factor for central nervous system and intestinal mucosa is under exhaustive investigation.
Subject(s)
Anemia/drug therapy , Erythropoietin/therapeutic use , Renal Insufficiency/drug therapy , Adult , Anemia/etiology , Anemia, Neonatal/drug therapy , Child , Child, Preschool , Erythropoietin/adverse effects , HIV Infections/complications , Hepatitis C/drug therapy , Humans , Infant , Infant, Newborn , Infant, Postmature , Neoplasms/complications , Recombinant Proteins , Renal Dialysis , Renal Insufficiency/complicationsABSTRACT
La eritropoyetina recombinante (rHuEPO) se ha transformado en la citoquina más utilizada terapéuticamente en el mundo. Luego del éxito obtenido en pacientes con insuficiencia renal terminal, se pudo establecer la utilidad de la terapia con rHuEPO para mejorar otras anemias, incluso en pacientes pediátricos y neonatos. El tratamiento o la prevención de la anemia del prematuro mediante el uso de rHuEPO llevó a una significativa reducción en cantidad de transfusiones y en exposición a dadores. Aún debe establecerse una clara definición sobre cuáles niños prematuros deben recibir tratamiento rutinariamente. Otras indicaciones en período neonatal incluyen anemias hiporregenerativas hemolíticas. La eficacia de la rHuEPO en niños mayores, con excepción de la insuficiencia renal crónica, no ha sido tan exhaustivamente evaluada como en adultos. Mientras que durante los últimos años se han realizado gran cantidad de estudios en adultos con anemia asociada al cáncer o a infección por HIV, permitiendo establecer conclusiones claras sobre su eficacia, sólo escasa cantidad de estudios con pequeño número de pacientes han sido realizados en niños. Hasta la fecha, los resultados sugieren que la terapia con rHuEPO en niños es tan útil como en adultos, pero la realización de estudios aleatorizados prospectivos incluyendo gran número de pacientes es esencial para alcanzar conclusiones definitivas. Los resultados de estudios dirigidos a evaluar la eficacia de la rHuEpo para mantener una dosis adecuada de ribavirina en pacientes en tratamiento por hepatitis C son alentadores. La utilización potencial de los efectos no hemopoyéticos de la rHuEPO en neonatos es un terreno novedoso y apasionante. El rol de la Epo como citoprotector para sistema nervioso central y mucosa intestinal está bajo investigación exhaustiva.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adult , Anemia/drug therapy , Erythropoietin , Renal Insufficiency , Anemia, Neonatal/drug therapy , Anemia/etiology , Erythropoietin , HIV Infections/complications , Hepatitis C/drug therapy , Infant, Postmature , Neoplasms/complications , Renal Dialysis , Renal InsufficiencyABSTRACT
La eritropoyetina recombinante (rHuEPO) se ha transformado en la citoquina más utilizada terapéuticamente en el mundo. Luego del éxito obtenido en pacientes con insuficiencia renal terminal, se pudo establecer la utilidad de la terapia con rHuEPO para mejorar otras anemias, incluso en pacientes pediátricos y neonatos. El tratamiento o la prevención de la anemia del prematuro mediante el uso de rHuEPO llevó a una significativa reducción en cantidad de transfusiones y en exposición a dadores. Aún debe establecerse una clara definición sobre cuáles niños prematuros deben recibir tratamiento rutinariamente. Otras indicaciones en período neonatal incluyen anemias hiporregenerativas hemolíticas. La eficacia de la rHuEPO en niños mayores, con excepción de la insuficiencia renal crónica, no ha sido tan exhaustivamente evaluada como en adultos. Mientras que durante los últimos años se han realizado gran cantidad de estudios en adultos con anemia asociada al cáncer o a infección por HIV, permitiendo establecer conclusiones claras sobre su eficacia, sólo escasa cantidad de estudios con pequeño número de pacientes han sido realizados en niños. Hasta la fecha, los resultados sugieren que la terapia con rHuEPO en niños es tan útil como en adultos, pero la realización de estudios aleatorizados prospectivos incluyendo gran número de pacientes es esencial para alcanzar conclusiones definitivas. Los resultados de estudios dirigidos a evaluar la eficacia de la rHuEpo para mantener una dosis adecuada de ribavirina en pacientes en tratamiento por hepatitis C son alentadores. La utilización potencial de los efectos no hemopoyéticos de la rHuEPO en neonatos es un terreno novedoso y apasionante. El rol de la Epo como citoprotector para sistema nervioso central y mucosa intestinal está bajo investigación exhaustiva. (AU)
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adult , Erythropoietin/therapeutic use , Anemia/drug therapy , Renal Insufficiency/drug therapy , Erythropoietin/administration & dosage , Erythropoietin/adverse effects , Anemia/etiology , Renal Insufficiency/complications , Anemia, Neonatal/drug therapy , Neoplasms/complications , HIV Infections/complications , Renal Dialysis , Hepatitis C/drug therapyABSTRACT
Presentamos una revisión de la literatura de los problemas hematológicos del feto más relevantes, con especial enfoque del diagnóstico y tratamiento prenatal.
Subject(s)
Humans , Pregnancy , Infant, Newborn , Anemia, Neonatal/diagnosis , Anemia, Neonatal/drug therapy , Anemia, Neonatal/therapy , Fetal Diseases/blood , Hematologic Diseases/complications , Hematologic Diseases/therapy , Erythroblastosis, Fetal/diagnosis , Erythroblastosis, Fetal/drug therapy , Erythroblastosis, Fetal/therapy , Thrombocytopenia/diagnosis , Chile/epidemiology , Pregnancy Complications, Hematologic , Prenatal Diagnosis , Thalassemia , ThrombocytopeniaABSTRACT
OBJECTIVE: To investigate whether recombinant erythropoietin (rhEPO) reduces the need for transfusion in extremely low birth weight (ELBW) infants (birth weight 500-999 g) and to determine the optimal time for treatment. METHODS: In a blinded multicenter trial, 219 ELBW infants were randomized on day 3 to one of 3 groups: early rhEPO group (rhEPO from the first week for 9 weeks, n = 74), late rhEPO group (rhEPO from the fourth week for 6 weeks, n = 74), or control group (no rhEPO, n = 71). All infants received enteral iron (3-9 mg/kg/day) from the first week. The rhEPO beta dose was 750 IU/kg/week. Success was defined as no transfusion and hematocrit levels never below 30%. RESULTS: Success rate was 13% in the early rhEPO group, 11% in the late rhEPO group, and 4% in the control group (P =.026 for early rhEPO versus control group). Median transfusion volume was 0.4 versus 0.5 versus 0.7 mL/kg/day (P =.02) and median donor exposure was 1.0 versus 1.0 versus 2.0 (P =.05) in the early rhEPO group, the late rhEPO group, and the control group, respectively. Infection risk was not increased and weight gain was not delayed with rhEPO beta. CONCLUSION: Early rhEPO beta treatment effectively reduces the need for transfusion in ELBW infants.
Subject(s)
Anemia, Neonatal/drug therapy , Blood Transfusion , Erythropoietin/therapeutic use , Infant, Very Low Birth Weight , Anemia, Neonatal/mortality , Cross Infection/epidemiology , Double-Blind Method , Europe/epidemiology , Female , Hematocrit , Humans , Infant, Newborn , Iron/metabolism , Iron/therapeutic use , Male , Proportional Hazards Models , Recombinant Proteins , Statistics, Nonparametric , Survival Rate , Time FactorsABSTRACT
Se evalúa el efecto de 100 mg IM de vitamina B12 mensual por 4 veces, sobre la evolución de la anemia del prematuro, en un estudio controlado, aleatorizado y doble ciego, en 55 niños de edad gestacional menor de 33 semanas. No se encontraron diferencias clínicamente significativas en la evolución hematológica ni en el crecimiento en los dos grupos estudiados. El número de transfusiones fue significativamente menor en ambos grupos que los reportados en la literatura
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Anemia, Neonatal/drug therapy , Vitamin B 12/therapeutic use , Blood Cells , Double-Blind Method , Infant, Premature , Infant, Small for Gestational Age/metabolism , Vitamin B 12/administration & dosageSubject(s)
Humans , Infant, Newborn , Anemia, Neonatal/classification , Anemia, Neonatal/diagnosis , Anemia, Neonatal/drug therapy , Anemia, Neonatal/therapy , Anemia, Neonatal/genetics , Erythropoiesis/physiology , Erythropoietin/therapeutic use , Erythropoietin/administration & dosage , Erythropoietin/adverse effects , Complementary Homeopathic Drugs , Iron/administration & dosage , Iron/therapeutic use , Folic Acid/administration & dosage , Folic Acid/therapeutic use , Vitamin B 12/administration & dosage , Vitamin B 12/therapeutic use , Hematologic TestsABSTRACT
Background: Anemia is common among very low birth weight newborns and requires frequent blood tranfusions. Erythropoietin was been reported to be useful in the prevention of this anemia. Aim: To asses the benefits of early (before the third week of life) Human recombinant Erythropoietin (r-EPO) administration to reduce the requirement of blood tranfusions in very low birth weight newborns. Patients and methods: sixty newborns under 1500g of birthweight were randomly assigned to recive r-EPO (n=29) or placebo (n=31) three times per week, during four weeks. Packed red cell volume and reticulocyte counts were measured weekly. Serum erythropoietin was measured prior to eigth dose. Transfusion requirements were recorded. Results: r-EPO reduced transfusions from 1.41 ñ 1.1 to 0.69 ñ 1 transfusions/newborns (p<0.001). At the fourth week of treatment, reticulocyte count was 14.8 ñ 7 and 6.4 ñ 4.9 percent in the active treatment group and placebo group respectively (p<0.001). Conclusions: r-EPO reduces the requrement of transfusions in low birth weight infants
Subject(s)
Humans , Male , Female , Infant, Newborn , Erythropoietin/pharmacology , Infant, Premature, Diseases/drug therapy , Anemia, Neonatal/prevention & control , Infant, Premature, Diseases/prevention & control , Anemia, Neonatal/drug therapy , Double-Blind Method , Infant, Low Birth Weight , Blood TransfusionABSTRACT
Introducción. El objetivo del trabajo fue evaluar la utilidad de la eritropoyetina humana recombinante (rHu-Epo), a dosis bajas, en la prevención de la anemia del prematuro. Material y métodos. Se estudiaron 27 recién nacidos pretérmino con edad gestacional menor o igual a 32 semanas, peso al nacer menor o igual a 1500g, y edad postnatal de 4 a 21 días; los que se dividieron en dos grupos: el A (n=13) recibió rHu-Epo a dosis de 100 U/kg, subcutánea, 3 veces por semanas, desde la tercera hasta la décimo primer semana de vida y el B o grupo control al que no se le administró (n=14). Todos recibieron suplementación con hierro oral a dosis de 2 mg/kg/días. Las características hematológicas, requerimientos transfusionales y peso fueron estudiados durante 8 semanas. Resultados. Las características iniciales de ambos grupos fueron similares. Los valores de hemoglobina (Hb) y hematócrito (Hto) descendieron a las 4 y 8 semanas en los 2 grupos en forma significativa, en relación al inicio (P<0.05); al comparar las últimas determinaciones del grupo A (9.8 ñ 0.7 g/dL y 29.6 ñ 2.0 por ciento) contra el control (9.5 ñ 1.8 g/dL y 28.2 ñ 5.0 por ciento), respectivamente, no hubo diferencia estadística significativa; tampoco la hubo respecto a las necesidades de transfusión sanguínea tanto en el grupo tratado como en el control. La cuenta de reticulocitos no mostró diferencia estadística dentro de cada grupo, al comparar las cifras iniciales con las de las 4 y 8 semanas. No hubo diferencia significativa en los valores de leucocitos, plaquetas, hierro sérico e incremento ponderal, al comparar el grupo con rHu-Epo con el control. Ningún efecto tóxico fue atribuible a lo rHu-Epo. Conclusión. La administración de la rHu-Epo a las dosis señaladas, no es útil en la prevención de la anemia del prematuro; debe considerarse un medicamento aún en investigación y que no debe de emplearse de manera rutinaria
Subject(s)
Humans , Male , Female , Infant, Newborn , Anemia, Neonatal/blood , Anemia, Neonatal/diagnosis , Anemia, Neonatal/drug therapy , Birth Weight , Erythropoietin/administration & dosage , Erythropoietin/therapeutic use , Gestational Age , Hematocrit , Hemoglobins , Infant, Premature/blood , Iron/blood , Reticulocyte CountSubject(s)
Anemia, Neonatal/drug therapy , Erythropoietin/therapeutic use , Infant, Premature, Diseases/drug therapy , Anemia, Neonatal/blood , Anemia, Neonatal/diagnosis , Erythrocyte Count , Erythropoietin/metabolism , Erythropoietin/pharmacokinetics , Humans , Infant, Newborn , Infant, Premature, Diseases/blood , Infant, Premature, Diseases/diagnosis , Infant, Very Low Birth Weight , Recombinant ProteinsABSTRACT
OBJECTIVE: To determine whether intravenously administered iron supplements would improve the hematologic response to recombinant erythropoietin in stable preterm infants. METHODS: Forty-two preterm infants (<33 weeks' gestation, birth weight < 1500 gm, hematocrit <38%) were treated with recombinant human erythropoietin (Eprex), 600 U/kg per week, and randomly assigned to receive either an oral preparation of ferrous lactate (elemental iron, 12 mg/kg per day) or an intravenous preparation of iron sucrose (6 mg/kg per week). RESULTS: Hematocrits, reticulocyte counts, and transfusions were similar in the oral group (OG) and the intravenous group (IVG). However, markedly higher serum ferritin concentrations were noted in the IVG (p <0.001), and by completion of the study the arithmetic mean values were 265 +/- 127 microg/L versus 137 +/- 65 microg/L in the IVG and the OG, respectively. The numbers of hypochromic erythrocytes increased in both groups during the study but were significantly higher in the OG (p = 0.04). Mean daily weight gain in the IVG (27 +/- 6.4 gm/day) was greater than in the OG (22.9 +/- 4.78 gm/day; p = 0.04). CONCLUSIONS: High doses of both orally administered iron and intravenously administered iron sucrose appear to supply sufficient iron for erythropoiesis in stable infants. Storage iron may become depleted after oral supplementation. The intravenous preparation appears to be safe and maintains serum ferritin concentrations, and it may be indicated for patients with low ferritin levels and for those not established on enteral feedings.