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

2021; Springer Nature; Volume: 90; Issue: 1 Linguagem: Inglês

10.1038/s41390-020-01273-w

1530-0447

Phuong T. Vu, Robin K. Ohls, Dennis E. Mayock, Kendell German, Bryan A. Comstock, Patrick J. Heagerty, Sandra E. Juul, Rajan Wadhawan, Sherry E. Courtney, Tonya Robinson, Kaashif A. Ahmad, Ellen Bendel‐Stenzel, Mariana Baserga, Edmund F. LaGamma, L. Corbin Downey, Raghavendra Rao, Nancy Fahim, Andrea Lampland, Ivan D. Frantz, Janine Y. Khan, Michael Weiss, Maureen Gilmore, Nishant Srinivasan, Jorge Perez, Victor McKay, Billy Thomas, Nahed O. ElHassan, Sarah B. Mulkey, Vivek K. Vijayamadhavan, Neil Mulrooney, Bradley A. Yoder, Jordan S. Kase, Jennifer Check, Semsa Gogcu, Erin Osterholm, Sara E. Ramel, Catherine M. Bendel, Cheryl A. Gale, T. Neville George, Michael Georgieff, Tate Gisslen, Sixto F. Guiang, Dana E. Johnson, K. Pfister, Heather Podgorski, Kari E. Roberts, Erin C. Stepka, Melissa L. Engel, Heidi Kamrath, Johannah M. Scheurer, Angela Hanson, Katherine M. Satrom, Elizabeth Zorn, Camilia R. Martin, Deirdre O’Reilly, Nicolas Porta, Raye‐Ann de Regnier, Catalina Bazacliu, Frances J. Northington, Raul Chavez‐Valdez, Patel Saurabhkumar, Magaly Diaz-Barbosa, Amy Silvia, Bailey Clopp, John Feltner, Isabella Esposito, Stephanie Hauge, Samantha Nikirk, Debbie Ott, Ariana Franco Mora, Pamela Hedrick, Vicki Flynn, Andrea Purnell, Emilie Loy, Natalie Sikes, Melanie Mason, Jana McConnell, Tiffany Brown, Henry Harrison, Denise J. Pearson, Tammy Drake, Jocelyn H. Wright, Debra Walden, Annette Guy, Jennifer Nason, Morgan Talbot, Kristen Lee, Sarah Penny, Terri Boles, Melanie Drummond, Katy Kohlleppel, Charmaine Kathen, Brian Kaletka, Shania Gonzales, Cathy Worwa, Molly Fisher, Tyler Richter, Alexander Ginder, Brixen A. Reich, Carrie A. Rau, Manndi C. Loertscher, Laura Bledsoe, Kandace M. McGrath, Kimberlee Weaver Lewis, Jill Burnett, Susan T. Schaefer, Karie Bird, Clare Giblin, Rita Daly, Kristi Lanier, Kelly Warden, Jenna Wassenaar, Jensina Ericksen, Bridget Davern, Mary Pat Osborne, Brittany Gregorich, Susan Pfister, Neha Talele, Evelyn Obregon, Tiglath Ziyeh, Molly Clarke, Rachel E. Wegner, Palak Patel, Molly Schau, Annamarie Russow, Kelly Curry, Susan Sinnamon, Lisa Barnhart, Charlamaine Parkinson, Sandra Sundquist Beauman, Mary Hanson, Elizabeth Kuan, Conra Backstrom Lacy, Edshelee M. Galvis, Susana Bombino, Arturo Serize, Jorge Jordán, Denise Martinez, Suzi Bell, Corrie Long, Mark A. Konodi, Christopher Nefcy, Roberta A. Ballard, Adam L. Hartman, Scott Janis, T. Michael O’Shea, John A. Widness,

Neonatal and fetal brain pathology

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.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.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.Transfusions in ELGANs were associated with worse outcomes. We speculate that strategies to minimize the need for transfusions may improve outcomes.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.