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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recombinant human erythropoietin (epoetin) has become the most widely used cytokine in the world. Following the success of its use in patients with end-stage renal disease, the usefulness of epoetin in other anaemias was assessed, including paediatric patients, mainly newborns. The treatment or prevention of anaemia of prematurity with epoetin resulted in a significant reduction in the number of transfusions and donor exposure. A clear definition of which premature babies must receive therapy is yet to be established. Other indications in neonatal period include hyporegenerative and haemolytic anaemias. The potential for use of the nonhaematopoietic effects of epoetin in newborn infants is a novel and exciting issue. The role of epoetin as a tissue-protective factor for the CNS and intestinal mucosa is under exhaustive investigation. With the exception of chronic renal failure, in older children the efficacy of epoetin has not been evaluated as in adults. Although an impressive amount of studies were carried out during recent years in adult patients with cancer-related or HIV-infection-related anaemias, thus allowing clear conclusions to be established on its efficacy, only a few trials with a small number of patients have been reported in children. Up-to-date, results in paediatric patients suggest that epoetin therapy is as useful as in adult patients, but prospective, randomised trials including large number of patients are essential to achieve definitive conclusions.
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PMID:Erythropoietin: an update on the therapeutic use in newborn infants and children. 1593 99

Recombinant human erythropoietin (rHuEpo) has become the most widely used cytokine in the world. Following the success of its use in patients with end-stage renal disease, the usefulness of rHuEpo to ameliorate other anemias was assessed, including pediatric patients and newborn infants. The treatment or prevention of anemia of prematurity with rHuEpo resulted in a significant reduction in the number of transfusions and donor exposure. A clear definition of which premature babies must receive therapy needs yet to be established. Other indications in neonatal period include hyporegenerative and hemolytic anemias. With the exception of chronic renal failure, in older children the efficacy of rHuEpo has not been evaluated as in adults. While an impressive amount of studies were carried out during the last years in adult patients with cancer-related or HIV-infection-related anemias, allowing to establish clear conclusions on its efficacy, only a few trials with small number of patients have been reported in children. Up to date, results in pediatric patients suggest that rHuEpo therapy is as useful as in adult patients, but prospective, randomized trials including large number of patients are essential to achieve definitive conclusions. Results of studies designed to evaluate the efficacy of rHuEpo for sustaining an adequate dose of ribavirin in patients receiving treatment for hepatitis C are encouraging. The potential for use of the non-hematopoietic effects of rHuEpo in newborn infants is a novel and exciting issue. The role of rHuEpo as a tissue protective factor for central nervous system and intestinal mucosa is under exhaustive investigation.
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PMID:[Human recombinant erythropoietin therapy]. 1655 32

Pregnancy is rare in women with end-stage renal disease, and perinatal outcome remains suboptimal because of prematurity and foetal growth restriction. Successful obstetrical outcome in two women presented with chronic renal failure requiring serial haemodialysis and multiple blood transfusions during pregnancy is reported. Both women had vaginal delivery of low birth weight neonates--2100 g and 1540 g at 33 and 37 weeks' gestations respectively. With specialised neonatal care, both neonates survived, and the mothers were counselled for renal replacement therapy.
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PMID:Successful pregnancy outcome among women with end-stage renal disease requiring haemodialysis. 1981 Mar 68

In children with chronic kidney disease anaemia is seen very often. Depending of etiology and the degree of renal insufficiency is found up to 80%. The cause is mainly because of lowered production of erythropoietin in chronically damaged kidney, but also because of insufficient intake of iron and folic acid, or intake of some drugs. Erythropoietin is a hormone which is produced in kidneys. Its main role is influence on terminal differenciation of erythroid progenitors in bone marow, and also acts on eriythropoietin receptors. In most of children with chronic kidney disease plasma level of erythropoietin is lowered, or is diminished its binding on receptors in bone marrow. New era in anaemia treatment started with developement of recombinant human erythropoietin (alfa or beta epoetin) and darbepoetin alfa (somewhat different because of higher content of sialic acid in carbohydrate moiety of molecule). Last years is developed a novel epoetin which is given 1 times monthly (metoxy polietilenglycol-epoetin beta), while earlier drugs are administered 1-3 times weekly or once in 2 weeks. These drugs are called erythropoiesis stimulating agents (ESA).They are today widely used in children with chronic renal failure before dialysis, on haemodialysis or peritoneal dialysis and in patients after kidney transplantation with deterioration of graft function. Mostly are used when glomerular filtration rate is below 35 ml/min/1 .73m2, but in some patients below 50-60 ml/min/1.73 m2. Administration is via intravenous or supcutaneous route. Efficasy of subcutaenous administration is 30- 40% higher, so this route is preferred. Dosing depends (after correction of other causes of anemia) to maintain heglobin levels between 110-120 g/L, and not to exceed 130 g/L (or haematocrit levels 33-36%, and maximum levels 39%). Theyre initiation starts when hemoglobin level falls below 80% of normal values for the age. In children older than 6 years at hemoglobin <100 g/L, or hematocrit <33%. During these therapy almost allways is need for iron supplementation intravenously or peroral. Advantages of the use of ESA are multiple: there is no need for blood transfusion, and therefore lowered risk for panel reacting antibodies (PRA) or HLA antibodies. There is also lowered risk for blood transmission of viruses. The use of erythropoietin is also in anaemia of prematurity, or in some malignant diseases to enable chemotherapy or radiation procedures. Also is used in some elective surgery procedures. Its use is safe and has proven cost-benefit, with low side effects in experienced medical team. With better hemoglobin levels there is improvement of cardiovascular system, better apetite, better growth and developement of child, so as physical and mental activity and sense of well-being.
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PMID:[Characteristics of anaemia treatment in children with chronic kidney disease]. 2023 52


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