The following is a summary of “Supplemental Iron and Recombinant Erythropoietin for Anemia in Infants Born Very Preterm: A Survey of Clinical Practice in Europe,” published in the September 2024 issue of Pediatrics by Reibel-Georgi et al.

This study aims to survey the practices regarding iron and recombinant human erythropoietin (rhEpo) administration to preterm infants across Europe. Over a three-month period, an online survey was distributed to 597 neonatal intensive care units (NICUs) in 18 European countries, specifically targeting those treating infants born with a gestational age (GA) of less than 32 weeks. Of the 597 NICUs surveyed, 343 responded, yielding a response rate of 56.3%. The results indicated that nearly all NICUs (97.7%) routinely administer enteral iron, with 74.3% supplementing all infants born before 32 weeks’ GA. Additionally, 65.3% of NICUs routinely assess erythropoiesis and iron parameters beyond day 28 after birth. 

Most NICUs initiate iron supplementation at a postnatal age of two weeks, continuing until 6 months (34.3%) or 12 months (34.3%). The routine use of rhEpo was reported by 22.2% of NICUs, with individual cases in 6.9% of centers. RhEpo is primarily administered subcutaneously (70.1%), with the most common dosage being 250 U/kg three times a week (44.3%), though dosing varied significantly among centers. The survey reveals considerable variability in assessing erythropoietic activity and iron deficiency in preterm infants, suggesting that the current practice may need to be adequately supported by evidence. Moreover, the application of rhEpo in clinical practice appears inconsistent with existing evidence regarding its efficacy and safety. These findings underscore the necessity for standardized protocols to enhance blood management strategies and optimize the treatment of anemia in premature infants.

Source: sciencedirect.com/science/article/abs/pii/S0022347624004050