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Shahid Nazir, MD; Ricardo L. Peverini, MD; Douglas D. Deming, MD; Andrew O. Hopper, MD; Nidia R. Vyhmeister, MD

Arch Pediatr Adolesc Med. 2002;156:540-544.

Objective  To compare iron sufficiency in premature infants receiving high-dose recombinant human erythropoietin (r-HuEPO), 1200 IU/kg per week, supplemented with 6 or 12 mg/kg per day of enteral iron.

Design  We conducted a prospective, double-blind, controlled study of premature infants receiving r-HuEPO therapy, randomly assigned to receive 2 different doses of iron. Measurements of ferritin, iron, total iron-binding capacity, reticulocyte count, hemoglobin level, and hematocrit were obtained at baseline, 4, and 6 weeks. Transferrin saturation was calculated; the number of blood transfusions and the incidences of sepsis were recorded.

Setting  This study was performed in the neonatal intensive care unit at Loma Linda University Children's Hospital, Loma Linda, Calif.

Subjects  Infants with a gestational age of 32 weeks or younger, older than 7 days, and receiving r-HuEPO therapy from March 1, 1997, to June 30, 1998, were eligible for the study. Infants were randomly assigned to receive 6 mg/kg per day or 12 mg/kg per day of enteral iron during a course of r-HuEPO therapy for 4 to 6 weeks.

Results  Sixty-four infants were enrolled in the study. Twelve infants did not complete the study; 52 completed 4 weeks and 41 completed 6 weeks of the study. While ferritin levels and transferrin saturation decreased in both groups over the study period, there were no differences between the 2 study groups.

Conclusions  Infants receiving high-dose r-HuEPO therapy (1200 IU/kg per week) decrease their ferritin levels (measure of iron stores) even when receiving high enteral iron supplementation. Given that the ferritin levels were similar between the 2 groups, we speculate that the additional iron either was not absorbed or was not stored.

From the Department of Pediatrics, Loma Linda University School of Medicine (Drs Peverini, Deming, Hopper, and Vyhmeister), Loma Linda, Calif. Dr Nazir is in private practice in Colton, Calif.

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