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A prospective randomized pilot trial comparing weekly vs. biweekly Darbepoetin administration to preterm infants

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Background

Administering darbepoetin (Darbe) to preterm infants stimulates erythropoiesis, increases red blood cell (RBC) mass, and reduces RBC transfusions. We typically administer 10 µg/kg weekly until 34 weeks corrected gestation; however, we are uncertain whether this dose could be given every other week (biweekly) with equal efficacy.

Methods

Infants ≤32 weeks were randomized to receive Darbe 10 µg/kg/dose weekly or biweekly for six weeks, tracking complete blood counts, absolute reticulocyte counts (ARC), iron status (RET-He), and RBC transfusions.

Results

We enrolled 71 infants (1027 ± 369 grams, 27.3 ± 2.8 weeks). During the study period, the weekly-dosed group had a higher adjusted mean ARC (48,000/μL higher, 95% C.I. 9700–87,000/μL; p = 0.019). However, RET-He, Hgb, and transfusion-free survival were not different between groups (p = 0.071, p = 0.244, and p = 0.762).

Conclusions

Weekly Darbe results in a higher six-week ARC than biweekly dosing. However, given similar clinical outcomes, perhaps biweekly dosing may be a cost-effective alternative.

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Fig. 1
Fig. 2: Laboratory outcomes during the study period by treatment arm.
Fig. 3: Kaplan–Meier curves for red blood cell (RBC) transfusion-free status across the study period, separated by group.

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Data availability

Inquiries regarding sharing de-identified data sets and computer code can by made to the corresponding author. Deidentified data will be shared on request to the corresponding author.

Code availability

Inquiries regarding sharing de-identified data sets and computer code can by made to the corresponding author.

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Acknowledgements

The authors thank the parents of the study subjects for their willingness to allow their infants to participate, and the staff and coordinators at the Newborn Intensive Care Units at Utah Valley Hospital and Intermountain Medical Center.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Timothy M. Bahr, Robert D. Christensen, Erick Gerday & Robin K. Ohls

  2. Department of Neonatology, Intermountain Health, Murray, UT, USA

    Timothy M. Bahr, Robert D. Christensen, Kimberlee A. Weaver-Lewis, Danielle M. Scott & Erick Gerday

  3. University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Jared J. Tuttle

Authors
  1. Timothy M. Bahr
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  2. Robert D. Christensen
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  3. Kimberlee A. Weaver-Lewis
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  6. Jared J. Tuttle
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  7. Robin K. Ohls
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Contributions

TMB, RDC, and RKO; conception and design, assembly of data, data analysis, manuscript writing, final approval of the manuscript. KAW-L; overseeing nursing participation, final approval of the manuscript. DMS; conception and design, overseeing pharmacy participation, final approval of the manuscript. JJT, EG; conception and design and final approval of the manuscript.

Corresponding author

Correspondence to Timothy M. Bahr.

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Bahr, T.M., Christensen, R.D., Weaver-Lewis, K.A. et al. A prospective randomized pilot trial comparing weekly vs. biweekly Darbepoetin administration to preterm infants. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02247-8

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