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

Abstract

Objective: Preterm infants frequently receive red cell transfusions; however, the effect of transfusions on cognition is unclear. We evaluated the relationship between transfusions and cognitive outcomes in preterm infants enrolled in a randomized trial of erythropoiesis stimulating agents (ESAs). Study Design: Preterm infants were randomized to ESAs or placebo during initial hospitalization, and transfusions recorded. Children were evaluated using standard developmental tests of cognition at 18–22 months (56 ESA, 24 placebo) and 3.5–4 years (39 ESA, 14 placebo) Results: Cognitive scores at 18–22 months were inversely correlated with transfusion volume at (p=0.02). Among those receiving ≥1 transfusion, cognitive scores were significantly higher in the ESA-treated group (p=0.003). At 3.5–4 years, transfusions weren’t correlated with cognitive scores. Conclusions: In the placebo group, transfused children had lower cognitive scores than did non-transfused children at 18–22 months. In the ESA group, cognitive scores did not differ by transfusion status, suggesting ESAs provide neuroprotection.

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

“…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 ).…”

Impact of level of neonatal care on phlebotomy and blood transfusion in extremely low birthweight infants: a prospective, multicenter, observational study

“…Red cell transfusions improve oxygen delivery in sick neonates. However, there are substantial risks that result in short- and long-term morbidities and mortality ( 12 , 15 , 22 ). ELBW infants by virtue of their prematurity have physiological anemia.…”

“…Studies report that the rate of at least one red cell transfusion in ELBW infants is greater than 90% (11,15). Red cell transfusions expose infants to pro-inflammatory cytokines and free iron which may result in transfusion-related adverse events such as retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), NEC, impaired neurodevelopmental outcomes, and mortality (15)(16)(17)(18)(19)(20)(21)(22)(23). Therefore, several postnatal strategies have been adopted to improve red cell volume through delayed umbilical cord clamping, early use of recombinant erythropoietin, tolerance of low hemoglobin levels, and prevention of further blood loss (15,24).…”