Neurocognitive profiles of preterm infants randomly assigned to lower or higher hematocrit thresholds for transfusion

Abstract

Objective: Preterm infants are frequently transfused with red blood cells based on standardized guidelines or clinical concerns that anemia taxes infants' physiological compensatory mechanisms and thereby threatens their health and well-being. The impact of various transfusion guidelines on long-term neurocognitive outcome is not known. The purpose of this study is to evaluate long-term neurocognitive outcome on children born prematurely and treated at birth with different transfusion guidelines.

Methods: Neurocognitive outcomes were examined at school age for 56 preterm infants randomly assigned to a liberal (n = 33) or restrictive (n = 23) transfusion strategy. Tests of intelligence, achievement, language, visual-spatial/motor, and memory skills were administered. Between-group differences were assessed.

Results: Those in the liberal transfusion group performed more poorly than those in the restrictive group on measures of associative verbal fluency, visual memory, and reading.

Conclusions: Findings highlight possible long-term neurodevelopmental consequences of maintaining higher hematocrit levels.

Keywords:

• Preterm
• Neuropsychology
• Red blood cell transfusion
• Hematocrit
• Longitudinal

Acknowledgments

This publication was made possible by Grant Number UL1RR024979 from the National Center for Research Resources (NCRR), a part of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CTSA or NIH and our PPG (NIH Program Project Grant P01 HL046925). We would also like to acknowledge the ICTS/CTSA CRU for their assistance with and support of this project.