Optimized Erythropoietin (EPO) Treatment (OETNA)
Neonatal Anemia
About this trial
This is an interventional prevention trial for Neonatal Anemia focused on measuring Neonatal, Anemia, Transfusion, Erythropoetin, Epoetin Alpha, Red Blood Cell, Survival, Pharmacodynamics, Model
Eligibility Criteria
Inclusion Criteria:
- Post-menstrual age at birth less than 37 wk;
- birth weight of 1,001 to 1,500 g;
- postnatal age <48 h;
- respiratory distress requiring ventilation;
- signed consent by parent or guardian.
Exclusion Criteria:
- Anticipated survival <72 h;
- Hemolytic anemia due to alloimmune disease (including due to ABO), and other hemolytic disease processes;
- Major anomalies that are life-threatening during the neonatal and infant periods (central nervous system, cardiac, metabolic chromosomal including, but not limited to, trisomies, deletions, and trinucleotide repeats);
- Clinical seizures;
- Congenital thrombotic or hemorrhagic conditions including disseminated intravascular coagulation;
- Positive blood or spinal fluid bacterial or fungal culture, or other laboratory and/or clinical data indicative of sepsis, including TORCH infections, prior to 48 h of age;
- Hematocrit >50%;
- Platelet count >400,000 per µL in first 48 h of life;
- Hypertension with systolic blood pressure >100 mm Hg.
- Any condition, in the opinion of the investigators, that would compromise the well being of the subject or the study, or prevent the subject from meeting or performing study requirements.
Sites / Locations
- University of Iowa Hospitals and Clinics
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Placebo Comparator
Experimental
Epoetin Alpha study 1
Epoetin Alpha study 2
Biotinylated red blood cells
Epoetin Alpha Tthe number of separate doses (per kg) to be given over 4 weeks by day of age will not exceed 10. These will be administered as follows: day of life (DOL) 2 (1200 U), DOL 4 (600 U), DOL 5 (600 U), DOL 6 (600U), DOL 7 (600 U), DOL 9 (600 U), DOL 14 (600 U), DOL 15 (600 U), DOL 16 (1200 U), and DOL 28 (600 U). The greatest dose in any 1 wk period is 3600 U. Infant study 1 Drug Intervention: all infants will be treated with Epoetin Alpha during the first four weeks of life to provide data for determining: 1) the PK/PD model determined optimized Epoetin Alpha dosing schedule; and 2) clinical and laboratory covariates predictive of which infants are good and poor Epoetin Alpha responder.
Epoetin Alpha dosing schedule will be determined based on the results of Infant Study 1. Infant Study 2 is a randomized, masked study to test the hypothesis that optimized Epoetin Alpha treatment of VLBW infants predicted to be good responders will result in the elimination of RBCTx relative to poor responders. Infant Study 2 in Years 4 and 5 will make use of the knowledge acquired in Infant Study 1 to test the central hypothesis that RBCTX can be eliminated in the majority of good Epoetin Alpha responders by optimal administration of Epoetin Alpha, but only marginal reductions in RBCTx will occur in the poor Epoetin Alpha responders.
Individual fetal RBC lifespans will be determined by administering biotinylated red blood cells, both autologous and allogeneic, simultaneously. Left over red blood cells are examined to determine red cell survival.