***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To compare the neurodevelopmental outcome of premature infants treated with recombinant human erythropoietin  with that of control infants . STUDY DESIGN : A total of 20 treated infants and 20 control infants who had completed r and omized , double-blind , placebo-controlled studies of recombinant human erythropoietin as treatment for anemia of prematurity were followed for growth and developmental outcome in an intensive care nursery follow-up program . Infants were assessed by st and ard developmental tests . RESULTS : No differences were found between groups for neurologic outcome , cognitive outcome , or growth patterns . All infants treated with recombinant human erythropoietin were neurologically normal . The rate of cognitive deficits was similar in the two groups . CONCLUSION : In this small sample we did not see differences in neurodevelopmental outcome between infants treated with recombinant human erythropoietin and control infants The effectiveness of recombinant human erythropoietin ( r-HuEpo ) in raising haemoglobin concentrations in very low birthweight infants was examined in a r and omised multicentre study . Twenty nine ' healthy ' appropriate for gestational age infants with birth weights 900 - 1400 g entered the study at 3 weeks of age . All infants received breast milk supplemented with 9 g/l human breast milk protein from 3 to 8 weeks of age . Eighteen mg iron was given daily from week 3 and was doubled if serum iron concentration fell below 16.0 mumol/l . Fourteen infants were r and omised to receive 100 U/kg r-HuEpo subcutaneously three times a week from week 3 to week 7 ; 15 infants served as controls . After one week reticulocyte and haemoglobin concentrations were significantly higher in the r-HuEpo treated group and the haemoglobin values remained significantly higher throughout r-HuEpo treatment and at the concentrations observed in full term infants . No adverse effects were associated with the treatment . In stable very low birthweight infants with optimal iron and protein intakes , moderate dose r-HuEpo can produce significant gains in red cell production that may be clinical ly useful Because critically ill premature infants experience significant iron loss due to phlebotomy and have high iron needs for growth , Fe absorption and incorporation studies are clinical ly important . A prospect i ve , controlled , r and omized , open 21-d study was conducted in infants with birth weight < 1300 g and gestational age < 31 wk to assess the efficacy of combining intravenous ( IV ) sucrose iron ( Fe ) with erythropoietin ( EPO ) for increasing Fe absorption , RBC Fe incorporation , and erythropoiesis .  Three clinical ly stable groups were enrolled at 3 - 4 wk of age :  Control , EPO [ 2100 U EPO/(kg.wk ) ] ; and IV Fe+EPO [ 2 mg IV sucrose Fe/(kg.d ) plus 2100 U EPO/(kg.wk ) ] . All subjects received 9 mg/(kg.d ) of oral Fe polymaltose . Subjects were not allowed RBC transfusions . Indicators of iron status and erythropoiesis were assessed before and 18 d after treatment . On d 4 , tracer doses of oral polymaltose (57)Fe and IV sucrose (58)Fe were administered , and stool and blood sample s were collected for Fe absorption and incorporation determinations . Compared with the Control group , the EPO group demonstrated greater hemoglobin ( Hb ) concentration and reticulocyte count , but no difference in Fe incorporation . In contrast , the IV Fe+EPO group demonstrated greater total Fe incorporation , Hb concentration , plasma ferritin , and reticulocyte count compared with the Control and EPO groups . Absorption of (57)Fe and nonisotopic polymaltose Fe did not differ among the groups ( range : 48 - 58 % , and 41 - 47 % , respectively ) . We conclude that IV sucrose Fe administered in combination with  EPO  to very-low-birth weight premature infants significantly increases RBC Fe incorporation and erythropoiesis more than EPO alone , but without increasing iron absorption Anaemia of prematurity , a postnatal fall in haemoglobin concentration and haematocrit , is particularly common in those born at less than 32 weeks of gestation . Experimental and clinical data implicate inadequate erythropoietin production as an important reason . In this study recombinant human erythropoietin ( r-HuEpo ) was used in an attempt to treat or prevent this anaemia and thereby provide an alternative to erythrocyte transfusions . Premature infants ( birth weight ≤ 1250 g and gestational age ≤ 32 weeks ) , who were likely to need transfusions , were r and omly assigned to receive 4 weeks of treatment with either subcutaneously administered r-HuEpo ( 200 U ; n = 12 ) or placebo ( n = 12 ) , three times weekly . All patients had oral supplements of elemental iron at a dose of 3 mg/kg/day . Treatment was started in the third week of life . Reticulocyte counts were significantly raised ( P < 0.05 ) in the group treated with r-HuEpo at the end of treatment . The neonates in the group treated with r-HuEpo  needed fewer erythrocyte transfusions than those in the placebo group during treatment . There were no toxic effects attributable to r-HuEpo . The results indicate that treatment of infants with very low birth  weights with r-HuEpo will reduce their need for erythrocyte Abstract There is no consensus regarding protein intake and the doses of recombinant human erythropoietin ( r-HuEpo ) and iron in the treatment of anaemia of prematurity ( AOP ) . This open , r and omized study has compared the effectiveness of 50 IU r-HuEpo/kg with that of 100 IU/kg , both given subcutaneously thrice weekly . In addition , two different protein supplements have been compared ; lyophilized human milk protein and a commercial cow ’s milk product . Total protein intake was 3 g/kg per day . Daily iron dose was 18–36 mg . “ Healthy ” preterm infants ( n = 32 , birth weight : 800–1400 g , gestational age ≤ 31 weeks ) were studied from age 3 to 8 weeks . The two protein regimens yielded no differences in body growth , reticulocyte count or Hb concentration . In both r-HuEpo dose groups increased number of reticulocytes followed start of treatment ; higher levels were , however , found in the group receiving 100 IU/kg . Mean Hb concentration plateaued at 12 g/dl for infants receiving 100 IU/kg , at 11 g/dl in the 50 IU/kg group . Even though serum levels of ferritin and transferrin saturation indicated no iron deficiency , soluble transferrin receptor increased in both groups , more rapidly and to higher levels in the 100 IU/kg group . In addition , the number of infants having more than 8 % hypochromic red cells increased in both groups . Conclusions Commercial cow ’s milk protein added to human milk was as good as human milk protein supplementation in supporting growth and erythropoiesis . Fifty IU/kg r-HuEpo thrice weekly during AOP stimulated erythropoiesis significantly , but less so than 100 IU/kg . Even when using high oral doses of iron to preterms receiving r-HuEpo , our data suggested a certain degree of iron deficient erythropoiesis To assess the risks and benefits of erythropoietin versus erythrocyte transfusion in the treatment of the anemia of prematurity , we r and omly 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 , result ing 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 AIM To evaluate the role of recombinant human erythropoietin ( R-HuEpo ) in reducing iron infusion , which may exacerbate free radical damage , leading to chronic lung disease . METHODS A multicentre , r and omised , placebo  controlled , double blind study was carried out in four neonatal intensive care units in Yorkshire . Infants were r and omly allocated and received either R-HuEpo ( 480 U/kg/wk ) or placebo by twice weekly subcutaneous injection . The primary outcome measure was the number of days on respiratory support and a secondary outcome the number of blood transfusions required . RESULTS Forty two very low birthweight ( VLBW ) infants were r and omly allocated . There was little difference in the need for respiratory support one month after r and omisation , but subsequently there was a trend towards a reduction in the proportion requiring respiratory support in the R-HuEpo group ( difference at three months −0.50 , 95 % confidence interval −1.00 , 0.17 ) . During stay in hospital , the median number of blood transfusions was lower for infants in the R-HuEpo group ( difference in medians −2 , 95 % CI −4 , 0 ) . The study was stopped early because of failure to recruit babies at the expected rate . CONCLUSIONS R-HuEpo seems to reduce the number of days in oxygen for ill VLBW infants . These data could be used to construct a larger multicentre study to evaluate this effect further OBJECTIVE : To determine the effectiveness of a 10-day subcutaneous erythropoietin ( rHuEpo ) course of 300 units per kg per dose plus oral iron compared to oral iron alone in anemic infants during their convalescent phase of illness . STUDY DESIGN : Prospect i ve , r and omized trial performed at a 40-bed , teaching , referral , level III , neonatal intensive care unit . Infants with a gestational age at birth of less than 32 weeks , hematocrit of less than or equal to 28 % with a corrected reticulocyte count of less than or equal to 5 % , postconceptual age of less than 48 weeks or 5 months chronological age , and a diagnosis of anemia of prematurity were considered for inclusion . Major outcome parameters included hematocrit , corrected reticulocyte count and red cell transfusion requirements . RESULTS : A total of 60 infants were enrolled ( n=30 per group ) . Infants r and omized to rHuEpo had a significantly higher post-treatment hematocrit and corrected reticulocyte count than infants in the iron only group ( p<0.001 ) . There was a trend towards fewer red cell requirements in the rHuEpo group . CONCLUSIONS : The rHuEpo regimen studied here was associated with an acute improvement in hematocrit and corrected reticulocyte counts . This study did not demonstrate a statistically significant decrease in transfusion therapy , in part related to increased subsequent use of rHuEpo in the control group . Taken together , these data demonstrate that this regimen can effectively treat anemia in convalescent premature infants To determine whether recombinant erythropoietin ( r-HuEpo ) administered to very low birth weight infants 
    Output:
    
Late administration of EPO reduces the use of one or more RBC transfusions , the number of RBC transfusions per infant ( < 1 transfusion per infant ) but not the total volume ( mL/kg ) of RBCs transfused per infant .
Any donor exposure is likely not avoided as most studies included infants who had received RBC transfusions prior to trial entry .
Late EPO does not significantly reduce or increase any clinical ly important adverse outcomes except for a trend in increased risk for ROP .
The use of satellite packs ( dividing one unit of donor blood into many smaller aliquots ) may reduce donor exposure