E Lopez1, A Beuchée2, P Truffert3, N Pouvreau4, J Patkai5, O Baud6, F Boubred7, C Flamant8, P-H Jarreau5. 1. Réanimation néonatale, hôpital Clocheville, CHU de Tours, 49, boulevard Béranger, 37044 Tours cedex 9, France. Electronic address: e.lopez@chu-tours.fr. 2. Réanimation néonatale, CHU de Rennes, hôpital Sud, 16, boulevard Bulgarie, 35203 Rennes cedex 2, France. 3. Médecine néonatale, CHU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France. 4. Réanimation néonatale, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France. 5. Médecine et réanimation néonatales de Port-Royal, hôpitaux universitaires Paris Centre, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France. 6. Médecine et réanimation néonatales, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France. 7. Médecine et réanimation néonatales, AP-HM, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France. 8. Médecine et réanimation néonatale, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
Abstract
OBJECTIVE: 1/To assess the effectiveness and safety of EPO in reducing red blood cell (RBC) transfusions in preterm infants. 2/To provide guidelines for clinical practice in France. METHODS: 1/This systematic evidence review is based on PubMed search, Cochrane library. 2/Using French National Authority for Health methods concerning guidelines for clinical practice. RESULTS: Early EPO reduced the risk of RBC transfusions, donor exposure, and the number of transfusions in very preterm infants (LE2). Late EPO reduced the risk of RBC transfusions and the number of transfusions in very preterm infants (LE2). There is no difference between the effectiveness of early and late EPO (LE2). There is no difference between high-dose and low-dose EPO (LE2). The level of evidence is too low to recommend the intravenous route. EPO has no impact on the rate of bronchopulmonary dysplasia, necrotizing enterocolitis (LE3), and retinopathy of prematurity (LE2). The level of evidence is too low to recommend EPO for neuroprotection in very preterm or term infants. CONCLUSIONS: EPO to reduce RBC transfusion in very preterm infants is recommended (Level A). The optimal time to start therapy is unknown (Level B). The recommended dose is 750IU/kg/week via three subcutaneous injections for 6weeks (Level B).
OBJECTIVE: 1/To assess the effectiveness and safety of EPO in reducing red blood cell (RBC) transfusions in preterm infants. 2/To provide guidelines for clinical practice in France. METHODS: 1/This systematic evidence review is based on PubMed search, Cochrane library. 2/Using French National Authority for Health methods concerning guidelines for clinical practice. RESULTS: Early EPO reduced the risk of RBC transfusions, donor exposure, and the number of transfusions in very preterm infants (LE2). Late EPO reduced the risk of RBC transfusions and the number of transfusions in very preterm infants (LE2). There is no difference between the effectiveness of early and late EPO (LE2). There is no difference between high-dose and low-dose EPO (LE2). The level of evidence is too low to recommend the intravenous route. EPO has no impact on the rate of bronchopulmonary dysplasia, necrotizing enterocolitis (LE3), and retinopathy of prematurity (LE2). The level of evidence is too low to recommend EPO for neuroprotection in very preterm or term infants. CONCLUSIONS:EPO to reduce RBC transfusion in very preterm infants is recommended (Level A). The optimal time to start therapy is unknown (Level B). The recommended dose is 750IU/kg/week via three subcutaneous injections for 6weeks (Level B).