Eritropoietina no manejo da anemia da prematuridade: revisão da literatura

Abstract

Background: Prematurity, defined as birth before 37 weeks of gestational age, has a high prevalence worldwide. Preterm neonates are particularly vulnerable to multiple complications, including prematurity related anemia, a multifactorial condition related to erythropoietin (EPO) immaturity, low iron stores, and blood losses during hospitalization, resulting in high rates of red blood cell (RBC) transfusion. While anemia is associated with hemodynamic instability, hypoxia, and impaired neurodevelopment, transfusion also carries relevant risks, emphasizing the need for alternative strategies and restrictive transfusion protocols. Objective: To review the evidence regarding the efficacy and safety of erythropoietin use in preterm neonates. Methods: A narrative review was conducted through a bibliographic search in the PubMed database, including studies published between September 2019 and September 2025, using the keywords “neonatal anemia,” “erythropoietin,” and “blood transfusion.” Full-text articles addressing the use of erythropoietin for the prevention or treatment of anemia of prematurity in preterm neonates were considered. Studies not related to the topic, descriptive narrative reviews, and unavailable articles were excluded. Results: The 13 studies included in this systematic review, most consistently demonstrate the prophylactic and therapeutic efficacy of EPO use, with improvements in hematological parameters (hemoglobin, hematocrit, and reticulocytes) and reductions in RBC transfusion requirements in preterm infants. Prophylactic use showed greater impact on preventing anemia of prematurity and reducing transfusional exposure, whereas therapeutic use was effective in correcting established anemia and reducing subsequent transfusions. Benefits were less consistent in extremely preterm infants due to the high need for early transfusion. Efficacy was observed only with parenteral administration, either intravenous or subcutaneous. The most frequently reported regimen was parenteral EPO at a dose of 250 IU/kg per dose, administered three times per week, usually initiated after the first week of life and always combined with iron supplementation. Evidence for an association between EPO use and retinopathy of prematurity was weak and not confirmed by more recent studies, and no other significant adverse effects were consistently reported. Conclusion: Erythropoietin appears to be an effective and safe strategy for the prevention and treatment of prematurity related anemia, particularly in moderately and late preterm infants. Rational use of EPO, as part of standardized care strategies, may reduce transfusional exposure and its associated risks, without consistent evidence of increased serious adverse effects.