Transfusions and neurodevelopmental outcomes in extremely low gestation neonates enrolled in the PENUT Trial: a randomized clinical trial

for the PENUT Consortium, PENUT Site PIs, Non-Author Participants, PENUT Consortium Co-investigators, PENUT Research Coordinators, PENUT Executive Committee, PENUT Medical Monitor

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3 Scopus citations

Abstract

Background: Outcomes of extremely low gestational age neonates (ELGANs) may be adversely impacted by packed red blood cell (pRBC) transfusions. We investigated the impact of transfusions on neurodevelopmental outcome in the Preterm Erythropoietin (Epo) Neuroprotection (PENUT) Trial population. Methods: This is a post hoc analysis of 936 infants 24-0/6 to 27-6/7 weeks’ gestation enrolled in the PENUT Trial. Epo 1000 U/kg or placebo was given every 48 h × 6 doses, followed by 400 U/kg or sham injections 3 times a week through 32 weeks postmenstrual age. Six hundred and twenty-eight (315 placebo, 313 Epo) survived and were assessed at 2 years of age. We evaluated associations between BSID-III scores and the number and volume of pRBC transfusions. Results: Each transfusion was associated with a decrease in mean cognitive score of 0.96 (95% CI of [−1.34, −0.57]), a decrease in mean motor score of 1.51 (−1.91, −1.12), and a decrease in mean language score of 1.10 (−1.54, −0.66). Significant negative associations between BSID-III score and transfusion volume and donor exposure were observed in the placebo group but not in the Epo group. Conclusions: Transfusions in ELGANs were associated with worse outcomes. We speculate that strategies to minimize the need for transfusions may improve outcomes. Impact: Transfusion number, volume, and donor exposure in the neonatal period are associated with worse neurodevelopmental (ND) outcome at 2 years of age, as assessed by the Bayley Infant Scales of Development, Third Edition (BSID-III).The impact of neonatal packed red blood cell transfusions on the neurodevelopmental outcome of preterm infants is unknown.We speculate that strategies to minimize the need for transfusions may improve neurodevelopmental outcomes.

Original languageEnglish (US)
JournalPediatric Research
Early online dateJan 11 2021
DOIs
StateE-pub ahead of print - Jan 11 2021

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Publisher Copyright:
© 2021, International Pediatric Research Foundation, Inc.

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  • Journal Article

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