Treatment

• Delayed cord clamping increases Fe stores.

• Close control of blood sampling is important.

• Transfusion indications will vary in neonatal units—decide on clinical grounds, particularly if ventilated. The following are guidelines only:

- Prems <2 wk with Hb <14.0g/dL, Hct <40%.

432 • A rising reticulocyte count in some centres is used as a sign to withhold transfusion.

• Some studies have shown better weight gain in transfused infants (not confirmed by others).

• Fe supplementation (2mg/kg/d PO) after first 2 weeks and until iron sufficient.

• Erythropoietin—controversial. It can be effective but its indiscriminate use is not encouraged. Large randomised trials have shown it to have an effect, but its expense makes cost effectiveness a concern and modern neonatal practice has already reduced the need for transfusion making it less necessary. Its best use is probably reserved for transfusion avoidance in infants weighing <1000g. A suitable regimen would be 200-250u/kg SC x 3/week between day 3 and week 6.

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