141 - Efficacy of Erythropoietin for the Late Treatment of Anemia of Prematurity in a Level IV Neonatal Intensive Care Unit: A retrospective Single-Center Cohort Study

While many efforts have been made in recent years to minimize red blood cell transfusions in extremely low birth weight (ELBW, < 1000g) infants, at least 80% of patients in this population are estimated to receive at least one transfusion during their initial hospitalization.  Recombinant humanized erythropoietin (rEPO) has been proposed as a potential treatment for anemia of prematurity (AOP) given the role of erythropoietin in increasing red blood cell production. In our level IV neonatal intensive care unit (NICU), we do not use rEPO prophylactically.  However, as a result of a former quality improvement project aimed at minimizing donor exposure from blood transfusions, we utilized rEPO as a treatment option for AOP, despite a lack of literature to support the use of rEPO in this fashion.  We administered rEPO for anemia on a case-by-case basis after considering labs and the infant’s clinical status.  We initiated treatment with a three-day “burst” utilizing a dose of 500 units/kg subcutaneously daily, followed by maintenance dosing of 500 units/kg subcutaneously three times weekly on Monday, Wednesday, and Friday. Initiation and discontinuation criteria were not defined and highly dependent on prescriber preference, with an empiric observation that our providers tended to use rEPO when infants were 28 days of life and older. All patients initiated on erythropoietin were also given enteral iron supplementation as ferrous sulfate oral liquid for a total of 6 mg/kg/day including iron intake from feeds.

Objective:

To determine the average change in Hct from baseline after rEPO administration for the treatment of anemia of prematurity as well as describe the population in which erythropoietin is being utilized.

Design/Methods:

This retrospective chart review study included infants in 2019 -2020 who received erythropoietin for the treatment of anemia of prematurity.

Results:

There were 132 infants (median GA 29w, BW 1175g) representing 162 unique treatment courses included in the study (Table 1). The average change in hematocrit from baseline was 4.7% (SD 3.9%, p< 0.001) (Table 2). The median duration of therapy was 9 days, or 6 doses. Rise in hematocrit (Hct) was associated with a higher number of rEPO doses (P< 0.001) (data not shown) and higher postmenstrual age or day of age (p< 0.001) (Figure) .  

Conclusion(s):

Erythropoietin, as used at our institution, is effective at treating anemia of prematurity as evidenced by a clinically and statistically significant increase in hematocrit from baseline.