Comparing Erythropoietin, Darbepoetin and No Erythropoiesis-Stimulating Agent Treatment in Preventing Anemia of Prematurity: A Multi-Center Retrospective Study

Objectives: To compare the effects of two different erythropoiesis-stimulating agents [ESAs] and no treatment on the number of blood transfusions and hematocrit [Hct] level. Methods: A retrospective study. Kaplan Medical Center provided data on ESA-treated infants, comparing erythropoietin [EPO] given per protocol until 2018 and darbepoetin [DPO] given from 2018 onwards. Meir Medical Center’s data formed the control group. Data regarding ESA treatment were extracted from a computerized prospective database. A comparison of Hct levels at birth, 14 days of age, 1 month and before discharge and number of blood transfusions received during hospitalization was performed. Mean and standard deviation or median and interquartile range were used for continuous variables and frequency tables for categorical variables. Results: In total, 248 premature infants born between 2016 and 2021 under 1250 g, who survived beyond two weeks of age, were included. No significant differences were found between the EPO and DPO groups in terms of number of blood transfusions or Hct values. The control group received more blood transfusions after two weeks of age [0.8 ± 1.5 vs. 0.5 ± 1.2, p-value = 0.02]. In the treated group, higher Hct values were observed at one month of age [29.9 ± 4.2 vs. 37.9 ± 5.3, p-value < 0.01] and at discharge [29.7 ± 3.8 vs. 34.1 ± 4.6, p-value < 0.01] compared to the control group. Conclusions: ESA treatment was associated with higher hematocrit levels, and no significant differences in efficacy were found between EPO and DPO.