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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In an attempt to stimulate endogenous erythrocyte production and thereby provide an alternative to erythrocyte transfusions, we administered recombinant human erythropoietin (rHuEpo) in doses of 75 to 300 units/kg/wk to seven infants with the anemia of prematurity. Treatment was started between 21 and 33 days of life, maintained for 4 weeks, and was well tolerated. All the patients had low baseline serum erythropoietin levels. After rHuEpo therapy, the number of reticulocytes increased from a mean baseline count of 75 x 10(9)/L to 95, 141, and 165 x 10(9)/L on days 7, 10, and 14 of therapy, respectively. Correction or stabilization of the anemia was observed in six of seven patients, whose estimated total erythrocyte volume increased by 49% during therapy (vs a predicted increment of 18% in the absence of rHuEpo). In one patient, however, the hematocrit declined during the treatment, and in three of the responders a secondary fall in hematocrit was noted either during therapy or after its discontinuation. Serum iron and ferritin levels rapidly decreased after the initiation of rHuEpo therapy, and in most patients transient early thrombocytosis and late neutropenia were observed. These data suggest that rHuEpo may correct or stabilize the anemia of prematurity. Its effects, however, may be limited by a variety of factors, among which iron availability probably plays an important role. Controlled studies will be needed to confirm these preliminary observations.
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PMID:Effects of recombinant human erythropoietin in infants with the anemia of prematurity: a pilot study. 169 80

We have compared the relations between perinatal conditions and developmental outcomes at age four years for two cohorts of children with birthweights 2,300 g or less, who did not develop cerebral palsy--one from Southeastern Wisconsin (children born 1975-76) and the other from Copenhagen (children born 1980-82). We examined the general effects of parental education and socioeconomic status, the use of Cesarean section, the degree of prematurity and neonatal complications on outcome. The methods of latent path structural analysis were used to form two models among 15 latent variables: one for children from Copenhagen and a similar model for children from Wisconsin. The impact of parental education and socioeconomic status was somewhat greater in Wisconsin. Several neonatal complications were related to outcome in Wisconsin: the early condition of the infant, use of a respirator, pneumothorax, and anemia/apnea. The only neonatal complication with a significant relation to outcome in Copenhagen was pneumothorax and to a much lesser degree major germinal layer haemorrhage. The degree of prematurity per se had a greater impact in Copenhagen. The use of Cesarean section and mechanical ventilation in the smallest infants was much more frequent in Denmark, but no association could be shown between this increased use and improved developmental outcome.
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PMID:The relation between perinatal conditions and developmental outcome in low birthweight infants. Comparison of two cohorts. 170 28

Erythropoietin is a glycoprotein hormone that plays a vital role in erythropoiesis. It is mainly produced in the fetal liver till the third trimester of pregnancy. At that point, the kidney interstitium takes over this function and becomes the main source of erythropoietin. Hypoxia stimulates erythropoietin production by a mechanism that may require a heme protein as a second messenger. Erythropoietin stimulates the maturation of erythroid precursors (colony-forming unit-erythroid and burst-forming unit-erythroid) via at least two types of cell surface receptors. The higher-affinity receptors appear to be more important in modulating the effects of erythropoietin in vivo. Changes in intracellular calcium may ultimately mediate the action of erythropoietin on erythroid precursors. A specific and sensitive radioimmunoassay is now available for accurately measuring erythropoietin levels. All forms of erythrocytosis except polycythemia vera are associated with elevated erythropoietin levels. Levels are also high in cord blood obtained following fetal asphyxia. Reduced levels are seen in patients with anemia due to renal diseases. The response of erythropoietin to the degree of anemia appears to be attenuated in patients with cancer, chronic diseases, and human immunodeficiency virus (HIV) infection. Erythropoietin has been successfully used for treating patients with anemia due to renal failure. Its use has also been approved for the treatment of anemia patients receiving zidovudine for HIV infection. Encouraging results have been observed when erythropoietin was used to treat anemia due to rheumatoid arthritis, hematological malignancies, and prematurity. It has also been used to increase the yield of autologous blood collected prior to an elective surgical procedure. However, it has not proved to be useful in sickle cell anemia and myelodysplastic syndromes.
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PMID:Erythropoietin. Biology and clinical applications. 178 66

The anemia of prematurity is defined by a progressive decline in hemoglobin level occurring over the first 2 months of life. Unlike term newborns whose "physiologic anemia" rarely if ever necessitates any treatment, preterm infants may become anemic enough to have clinical symptoms that indicate a need for red blood cell transfusions. Various factors contribute to the development of this anemia. Some of these factors, such as the short life span of erythrocytes in preterm infants, increased sensitivity of the erythrocytes to oxidative injury, and the blood losses caused by repeated phlebotomies, would normally be expected to induce corrective reticulocytosis. Characteristically, however, this anemia is hyporegenerative. Thus, it is associated with relative reticulocytopenia, low serum erythropoietin levels, and bone marrow erythroid hypoplasia. The recent availability of recombinant human erythropoietin has opened new perspectives in the management of a variety of anemias. Based on current knowledge of the regulation and pathophysiology of fetal and neonatal erythropoiesis, recombinant erythropoietin may represent a logical and efficient alternative to giving red blood cell transfusions in the treatment of the anemia of prematurity. Clinical trials have been initiated in several countries using different approaches and methodology. At this early stage these trials do not yet fully affirm that recombinant erythropoietin can be used as the first-line therapy in infants with the anemia of prematurity. Our own observations, however, suggest that this agent is well tolerated by preterm infants and may exert a corrective effect on the anemia of prematurity.
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PMID:Use of recombinant erythropoietin in treatment of the anemia of prematurity. 179 63

Prematurity in Indian births is modeled, based on the hypothesis that reduced protein and glucose and aminoacids and maternal anemia and preeclampsia lead to placental dysfunction which is also affected by metabolic disturbance and fetal circulation related to cellular growth and questions about genetics. There may be an ethnic propensity for early maturation of the fetus which affects the higher stillbirth rates and perinatal mortality. It was observed that among, for instance, black and Indian racial groups there may be meconium release and fetal distress. The significance is that physicians should increase antenatal surveillance before 40 weeks. Maternal nutrition should be advanced and hyperalimentation by cordocentesis. Other interventions such as glucose, oxygen, and aspirin administration are still very experimental. The evidence that velocity of growth is different and low birth weight is due to abnormal growth and shortened gestation is currently being researched among different ethnic groups. The discussion is concerned with reports of ethnic variation among Indian and Malay babies in Singapore and babies of French or African ancestry in France. In these studies findings were that the Indians and Malays in Singapore vs. the Chinese had higher mortality, and black African ancestry in mixed ancestry babies was related to higher infant mortality. Another study on neonatal mortality in India led to the recommendation that 2000 gm be established as the limit for defining low birth weight. In the 1501- 2000 gm birth weight groups, 30-45% are preterm, and the remainder are term or postterm. Low birth weight may transcend generations in India even with emigration. Experimental studies show that intrauterine weight is related to placental volume. Reduced growth and lower fetal insulin/glucose ratio with elevated fetal glycine/valine ratio was found to be related to reduced glucose supply among fetuses with fetal hypertriglyceridemia. Fat seems to be lacking among low birth weight fetuses. Studies of somatomedin and somatostatin in metabolism are helping to provide greater understanding of fetal growth processes.
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PMID:The prematurity paradox of the small Indian baby. 180 Mar 24

Circulating erythroid progenitors (BFU-E) in five anaemic preterm infants (haemoglobin less than 100 g/l) were about 2 and 4.4 times as abundant as in 10 preterm infants who were not anaemic and five healthy adults, respectively, and were significantly more responsive to low concentrations of recombinant human erythropoietin (rHuEpo) than those from healthy adults. These results encourage further studies in the use of rHuEpo for the treatment of the anaemia of prematurity.
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PMID:Erythropoietin responsive progenitors in anaemia of prematurity. 186 30

The outcome of 13 sets of triplet infants delivered between January 1, 1981, and December 31, 1988, is analyzed with specific regard to immediate neonatal morbidity. Thirty-nine viable infants were born with no perinatal deaths. Overall, 80% of triplet infants incurred some morbidity, including hyperbilirubinemia (51.3%), hypoglycemia (30.8%), respiratory distress syndrome (28.2%), respiratory compromise (23.1%), anemia (17.9%), patent ductus arteriosus (15.4%), and intraventricular hemorrhage (10.3%). All morbidities occurred in infants who averaged less than 2,000 g and 35 weeks' gestation at birth. As a background to understanding these observations, a review of reports of triplet morbidity and mortality in the United States and Europe is presented. Over the past 80 years, a continual decline in triplet perinatal mortality has occurred despite no change in the average gestational age at delivery over the past 40 years. The triplet perinatal mortality rate is now less than 10%, and prematurity is no longer as influential on perinatal mortality as it is on morbidity. Improvement in neonatal resuscitation and care and delivery by cesarean section are felt to be responsible for lower mortality rates. We believe that the optimum level of care for triplet gestations includes antenatal and neonatal care at tertiary perinatal centers and, except for special circumstances, delivery by cesarean section.
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PMID:Triplet pregnancy: changes in morbidity and mortality. 191 16

Extensive clinical studies have documented the effectiveness of recombinant human erythropoietin (rHuEPO) in correcting the anemia of adult dialysis patients, but the safety and efficacy of rHuEPO in children with renal anemia cannot yet be confirmed, due to the relative deficiency of reported studies involving pediatric subjects. To date, published experience with rHuEPO therapy in children has totaled 257 patients, although the majority of these reports have appeared only as abstracts. Overall experience has been favorable, with renal anemia and transfusion dependency successfully resolved in almost all pediatric patients reported. However, controlled clinical trials have not been performed, so it is not yet possible to clearly define the risks associated with rHuEPO therapy in children. Hypertension appears to occur or become worse in up to one third of treated children, but it is unclear to what extent rHuEPO therapy is accompanied by an increased risk of seizures, thrombosis of vascular access, hyperkalemia, hyperphosphatemia, or peritonitis (when administered via the intraperitoneal route). Only preliminary and somewhat conjectural recommendations can be offered regarding pediatric rHuEPO dosing, route of administration, special precautions, and adjunctive monitoring and therapy. Fortunately, a multicenter controlled clinical trial is underway that is designed to address these issues. Because the harmful effects of renal anemia are typically more profound for children than they are for adults, the benefits of rHuEPO promise to be even greater among pediatric patients. Whether rHuEPO therapy will substantially improve growth and neurologic and psychosocial development remains to be seen, but the potential is there for rHuEPO to dramatically improve the lives of children who suffer from the effects of the anemia of chronic renal failure. Other non-renal anemias that afflict pediatric patients, such as the anemia of prematurity, also may be amenable to rHuEPO therapy.
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PMID:Pediatric uses of recombinant human erythropoietin: the outlook in 1991. 192 79

Levels and risk factors for perinatal mortality in Ahmedabad, India, were investigated through an approach that combined institutional surveillance, a case-control survey, and a linked population-based survey. In the three government teaching hospitals in Ahmedabad, there were 15,893 births in July 1987-June 1988, of which 739 were stillbirths and 517 were early (within the first week of life) neonatal deaths. The case-control study collected detailed data on 451 of these stillbirths and 160 of the early neonatal deaths while the population-based survey covered 1102 women who delivered in the study period. The perinatal mortality rate in the study hospitals was 79/1000 births (46.4/1000 for stillbirths and 34.1/1000 for early neonatal deaths). The relative risk of perinatal mortality was 21.1 (95% confidence interval, 17.8-25.2) for preterm low-birthweight infants compared to full-term normal-birthweight babies, but only 2.6 (2.1-3.2) for full-term low-birthweight infants. Multivariate analysis indicated that the risks of both stillbirth and early neonatal mortality were significantly increased by a history of previous stillbirth, prematurity in the last pregnancy, low maternal weight, clinical anemia, no prenatal care, vaginal bleeding during pregnancy, elevated diastolic blood pressure, convulsions, antepartum hemorrhage, breech delivery, Cesarean section delivery, and congenital malformations. Socioeconomic factors such as low maternal education, agricultural occupation, and lack of a toilet lost all significance after adjustment for confounding factors. Overall, these findings suggest that improved maternal nutrition and antenatal/intrapartum care could have a substantial impact on reducing perinatal mortality in India.
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PMID:Levels and risk factors for perinatal mortality in Ahmedabad, India. 193 37

To assess the risks and benefits of erythropoietin versus erythrocyte transfusion in the treatment of the anemia of prematurity, we randomly assigned 19 anemic preterm infants (birth weight 988 +/- 227 gm; gestational age 27.6 +/- 1.2 weeks; age 41 +/- 15 days; all values mean +/- SD) to receive either transfusion or subcutaneously administered erythropoietin (200 units/kg every other day for 10 doses). In the 10 erythropoietin recipients, corrected reticulocyte counts increased from 2% +/- 1% to 7% +/- 2% (p less than 0.001) and hematocrits increased from 27% +/- 2% to 30% +/- 4% (p less than 0.05). In the nine infants who underwent transfusion, reticulocyte counts did not increase, but hematocrits increased from 28% +/- 4% to 41% +/- 2% after initial transfusion (p less than 0.001) and had decreased to 34% +/- 5% by day 20. Signs attributed to anemia (tachycardia, apnea with bradycardia, and poor weight gain) declined in both the erythropoietin recipients and those who underwent transfusion. However, five of nine infants who underwent transfusion had symptoms within 10 to 14 days and were given further transfusions. Marrow aspiration performed after 7 to 10 days of treatment showed that infants receiving erythropoietin had greater percentages of erythropoietic precursors (p less than 0.01), greater concentrations of mature erythroid progenitors (p less than 0.001), and higher cycling rates of erythroid progenitors (p less than 0.001). The percentage of mature stored neutrophils in marrow was lower in the erythropoietin group than in the transfusion group, resulting in an inverse myeloid/erythroid ratio (0.5:1 vs 6.2:1; p less than 0.001). After 20 days, absolute blood neutrophil counts were lower in the erythropoietin recipients (1.8 +/- 0.9 x 10(3) cells/microliters) than in the infants who underwent transfusion (3.9 +/- 1.9 x 10(3) cells/microliters; p less than 0.05). Administration of erythropoietin thus stimulated erythropoiesis and relieved signs attributed to anemia; the significance of the relative neutropenia remains to be determined. We conclude that erythropoietin administration offers promise as an alternative to erythrocyte transfusion in neonates with symptomatic anemia of prematurity.
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PMID:Recombinant erythropoietin compared with erythrocyte transfusion in the treatment of anemia of prematurity. 194 87


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