Long-term outcome of brain structure in female preterm infants: possible associations of liberal versus restrictive red blood cell transfusions

Abstract

Background

Preterm infants who receive differential red blood cell (RBC) transfusions at birth may show brain structure differences across development, including abnormalities in white matter (WM) structure and organization. This study investigated long-term outcomes of brain structure in female infants born preterm, at an average age of 13 years old, who received red blood cell (RBC) transfusions in the neonatal period according to a liberal or restrictive approach. Results from this study will increase understanding of the effects of transfusion on the developing brain.

Study design and methods

This follow-up study included female preterm infants who participated in a clinical trial and had been randomized at birth to either a liberal or restrictive hematocrit threshold. Brain structures were measured in childhood using structural magnetic resonance imaging (MRI) scans. Due to the low number of females in the restrictive transfusion group at follow-up, additional females were recruited for inclusion. Main outcome measures included cerebral and subcortical brain region volumes.

Results

Total intracranial volume was significantly decreased in females who were randomized to higher average hematocrit levels at birth. Infants in the liberal transfusion group had proportionately smaller volumes in all measures of regional cerebral WM and subcortical brain volumes, reaching significance for temporal lobe WM and caudate volumes.

Conclusion

Female premature infants who received a liberal transfusion threshold at birth had decreased WM volumes, which suggests the potential long-term neurodevelopmental risks associated with liberal transfusion practices.

Keywords:

• Brain
• brain structure
• premature
• preterm
• red blood cell
• transfusion

Disclosure statement

There are no conflicts of interest for any author.

Additional information

Funding

This study was supported by NIH grant 2P01HL046925, National Institute for Heart, Lung and Blood (NHLBI). Preterm Transfusions: Brain Structure and Function Outcomes.