Long-term outcome in relationship to neonatal transfusion volume in extremely premature infants: a comparative cohort study

Abstract

BackgroundIn premature born infants red blood cell (RBC) transfusions have been associated with both beneficial and detrimental sequels. Upon RBC transfusion, improvement in cerebral blood flow and oxygenation have been observed, while a more liberal transfusion policy may be associated with a better developmental outcome. The effect of the transfusion volume on long-term outcome is not known.MethodsObservational follow-up study of a cohort of extremely premature born infants, treated in 2 neonatal intensive care units using a different transfusion volume (15 ml/kg in Unit A and 20 ml/kg in Unit B). The primary outcome was a composite of post discharge mortality, neuromotor developmental delay, blindness or deafness, evaluated at a mean corrected age (CA) of 24 months related to the transfusion volume/kg bodyweight administered during the postnatal hospital stay.ResultsDespite the difference in transfusion volume in clinically comparable groups of infants, they received a similar number of transfusions (5.5 ± 3.2 versus 5.5 ± 2.3 respectively in Unit A and B). The total transfused volume in unit A was 79 ± 47 ml/kg and 108 ± 47 ml/kg in unit B (p = 0.02). Total transfused RBC volume per kg bodyweight was not an independent predictor of the composite outcome (p = 0.96, OR 1.0 (CI 0.9-1.1).ConclusionThere was no relationship between the composite outcome at 24 months CA and transfusion volume received during the post natal hospital stay. As there was no clinical advantage of the higher transfusion volume, a more restrictive volume will reduce total transfusion volume and donor exposure. Future research on the optimal transfusion volume per event to extreme preterm infants should include larger, prospective studies with a longer follow-up period through to childhood or even adolescence.

Adverse effects of red blood cell transfusions in neonates: a systematic review and meta‐analysis

“…Neurodevelopmental outcomes were the focus in two studies (3%) studies that included a total of 493 participants. Whyte et al defined adverse neurodevelopmental outcomes as cerebral palsy, cognitive delay (Mental Developmental Index <70), and severe visual or hearing impairment at 18 to 21 months of follow‐up; and von Lindern et al defined an adverse neurodevelopmental outcome as a composite outcome of post‐discharge mortality, severe hearing or visual impairment, and neuromotor development delay (<1 standard deviation below the mean) at 24 months. One study was a long‐term follow‐up of a previous randomized study, and the other was a retrospective study that included a comparator group .…”

Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies

“…In an observational follow-up study of premature infants receiving 2 different volumes of RBCT (15 vs. 20 mL/kg), the total transfused RBC volume per kilogram of bodyweight was not an independent predictor of the composite outcome ( p = 0.96, OR = 1.0; 95% CI 0.9–1.1) of post-discharge mortality, neuromotor developmental delay, blindness, or deafness, evaluated at a mean corrected age of 24 months [49]. …”

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

“…Reducing blood tests, advanced point of care blood analysers requiring smaller volume of blood 14 and implementing restrictive transfusion guidelines have reduced the frequency of transfusions in most neonatal units 15 . Two randomised clinical trials are currently undergoing to detect whether receiving restrictive or liberal blood transfusions improve long term neurodevelopmental outcomes in preterm infants 16,17 .…”