Background - Red blood cell (RBC) transfusion is often considered a life-saving measure in preterm neonates. However, it has been associated with detrimental effects on short-term morbidities and, recently, on brain development. The aim of the present study was to evaluate the association between RBC and long-term neurodevelopmental outcome in a cohort of preterm infants. Materials and methods - This retrospective cohort study was carried out in the period 2007-2013. Preterm infants with a gestational age (GA) ≤32 weeks and birthweight (BW) <1,500 g were included. Infants underwent Griffiths assessment at 24±6 months corrected age (CA) and at 5±1 years of age. We used a multivariate regression model to assess the association of RBC transfusions and long-term neurodevelopment after controlling for GA, being small for GA, major neonatal morbidities, and socio-economic status. We also evaluated the impact of early RBC administration (within the first 28 days of life) compared to those performed after the first month of life. Results - We enrolled 644 preterm infants, among whom 54.3% were transfused during their stay in the neonatal intensive care unit (NICU). In infants with a longitudinal follow-up evaluation (n=360), each RBC transfusion was independently associated with a reduction in the Griffiths General Quotient (GQ) by −0.96 (p=0.002) at 24 months CA. Early RBC administration had the biggest impact, especially in children without brain lesions, where the reduction in Griffiths GQ for each additional transfusion was −2.12 (p=0.001) at 24 months CA and −1.31 (p=0.006) at 5 years of age, respectively. Discussion - In preterm infants, RBC transfusions are associated with long-term neurodevelopmental outcome, with a cumulative effect. Early RBC administration is associated with a greater reduction in Griffiths scores. The impact of RBC transfusion on neurodevelopment is greater at 24 months CA, but persists, although to a lesser degree, at 5 years of age.

Red blood cell transfusions in preterm newborns and neurodevelopmental outcomes at 2 and 5 years of age / C. Fontana, G. Raffaeli, N. Pesenti, T. Boggini, V. Cortesi, F. Manzoni, O. Picciolini, M. Fumagalli, F. Mosca, S. Ghirardello. - In: BLOOD TRANSFUSION. - ISSN 2385-2070. - (2020). [Epub ahead of print] [10.2450/2020.0207-20]

Red blood cell transfusions in preterm newborns and neurodevelopmental outcomes at 2 and 5 years of age

Fontana, Camilla;Raffaeli, Genny;Cortesi, Valeria;Manzoni, Francesca;Fumagalli, Monica;Mosca, Fabio;
2020

Abstract

Background - Red blood cell (RBC) transfusion is often considered a life-saving measure in preterm neonates. However, it has been associated with detrimental effects on short-term morbidities and, recently, on brain development. The aim of the present study was to evaluate the association between RBC and long-term neurodevelopmental outcome in a cohort of preterm infants. Materials and methods - This retrospective cohort study was carried out in the period 2007-2013. Preterm infants with a gestational age (GA) ≤32 weeks and birthweight (BW) <1,500 g were included. Infants underwent Griffiths assessment at 24±6 months corrected age (CA) and at 5±1 years of age. We used a multivariate regression model to assess the association of RBC transfusions and long-term neurodevelopment after controlling for GA, being small for GA, major neonatal morbidities, and socio-economic status. We also evaluated the impact of early RBC administration (within the first 28 days of life) compared to those performed after the first month of life. Results - We enrolled 644 preterm infants, among whom 54.3% were transfused during their stay in the neonatal intensive care unit (NICU). In infants with a longitudinal follow-up evaluation (n=360), each RBC transfusion was independently associated with a reduction in the Griffiths General Quotient (GQ) by −0.96 (p=0.002) at 24 months CA. Early RBC administration had the biggest impact, especially in children without brain lesions, where the reduction in Griffiths GQ for each additional transfusion was −2.12 (p=0.001) at 24 months CA and −1.31 (p=0.006) at 5 years of age, respectively. Discussion - In preterm infants, RBC transfusions are associated with long-term neurodevelopmental outcome, with a cumulative effect. Early RBC administration is associated with a greater reduction in Griffiths scores. The impact of RBC transfusion on neurodevelopment is greater at 24 months CA, but persists, although to a lesser degree, at 5 years of age.
anaemia, neurodevelopment, prematurity, NICU, erythrocytes;
Settore MED/38 - Pediatria Generale e Specialistica
1-dic-2020
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/798218
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