Effect of blood transfusions on cognitive development in very low birth weight infants

Shah, Priya; Cannon, Daniel C.; Lowe, Jean; Phillips, J. P.; Christensen, Robert D.; Kamath‐Rayne, Beena D.; Rosenberg, Adam A.; Wiedmeier, Susan E.; Patel, Shrena; Winter, Sarah; Baker, Shawna; Ohls, Robin K.

doi:10.1038/s41372-021-00997-9

Cited by 8 publications

(1 citation statement)

References 31 publications

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“…Follow up of preterm infants (500–1,250 g) at 18–22 months who were involved in a randomized study investigating use of ESAs indicated a negative correlation between BSID-III scores and volume of transfusion ( r = 0.26; p = 0.02) ( 40 ).…”

Section: Possible Effects Of Transfusion Differences On Outcomesmentioning

confidence: 99%

Thresholds for blood transfusion in extremely preterm infants: A review of the latest evidence from two large clinical trials

2022

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There are two recently completed large randomized clinical trials of blood transfusions in the preterm infants most at risk of requiring them. Liberal and restrictive strategies were compared with composite primary outcome measures of death and neurodevelopmental impairment. Infants managed under restrictive guidelines fared no worse in regard to mortality and neurodevelopment in early life. The studies had remarkably similar demographics and used similar transfusion guidelines. In both, there were fewer transfusions in the restrictive arm. Nevertheless, there were large differences between the studies in regard to transfusion exposure with almost 3 times the number of transfusions per participant in the transfusion of prematures (TOP) study. Associated with this, there were differences between the studies in various outcomes. For example, the combined primary outcome of death or neurodevelopmental impairment was more likely to occur in the TOP study and the mortality rate itself was considerably higher. Whilst the reasons for these differences are likely multifactorial, it does raise the question as to whether they could be related to the transfusions themselves? Clearly, every effort should be made to reduce exposure to transfusions and this was more successful in the Effects of Transfusion Thresholds on Neurocognitive Outcomes (ETTNO) study. In this review, we look at factors which may explain these transfusion differences and the differences in outcomes, in particular neurodevelopment at age 2 years. In choosing which guidelines to follow, centers using liberal guidelines should be encouraged to adopt more restrictive ones. However, should centers with more restrictive guidelines change to ones similar to those in the studies? The evidence for this is less compelling, particularly given the wide range of transfusion exposure between studies. Individual centers already using restrictive guidelines should assess the validity of the findings in light of their own transfusion experience. In addition, it should be remembered that the study guidelines were pragmatic and acceptable to a large number of centers. The major focus in these guidelines was on hemoglobin levels which do not necessarily reflect tissue oxygenation. Other factors such as the level of erythropoiesis should also be taken into account before deciding whether to transfuse.

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Section: Possible Effects Of Transfusion Differences On Outcomesmentioning

confidence: 99%