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Long-term outcome of brain structure in premature infants: effects of liberal vs restricted red blood cell
Peg C Nopoulos1, Amy L Conrad, Edward F Bell
1University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA. peggy-nopoulos@uiowa.edu
Insights
Red blood cell transfusions in premature infants, particularly with liberal guidelines, led to smaller brain volumes at age 12. This highlights potential long-term neurodevelopmental impacts of transfusion strategies for anemia of prematurity.
Area of Science:
- Neonatal care and neurodevelopmental outcomes.
- Pediatric hematology and transfusion medicine.
Background:
- Anemia of prematurity is common in preterm infants.
- Red blood cell (RBC) transfusions are a standard treatment for anemia of prematurity.
- The long-term neurodevelopmental effects of different RBC transfusion thresholds are not fully understood.
Purpose of the Study:
- To evaluate the long-term brain structure outcomes in preterm infants at 12 years of age.
- To compare brain volumes in preterm infants who received liberal versus restricted RBC transfusion thresholds during neonatology.
- To compare brain volumes of preterm infants with healthy full-term control children.
Main Methods:
- A cohort of preterm infants from a clinical trial were followed up.
- MRI scans were obtained at approximately 12 years of age for 44 participants.
- Brain structures including intracranial volume, white matter, and subcortical nuclei were measured and compared between liberal transfusion, restricted transfusion, and control groups.
Main Results:
- Preterm infants receiving liberal RBC transfusions had significantly smaller intracranial volumes compared to controls.
- Reduced cerebral white matter volume was observed in both preterm groups, more pronounced in the liberal group.
- Subcortical nuclei volumes were decreased in both preterm groups compared to controls, with girls in the liberal group showing the most significant abnormalities.
Conclusions:
- Liberal red blood cell transfusion guidelines in preterm infants are associated with reduced brain volumes at 12 years of age.
- Transfusion strategies for anemia of prematurity can have lasting effects on brain structure.
- Further research is needed to optimize transfusion protocols for preterm infants to mitigate long-term neurodevelopmental risks.
Objective:
To assess the long-term outcome of brain structure in preterm infants, at an average age of 12 years, who received a red blood cell transfusion for anemia of prematurity.
Design:
As neonates, this cohort of infants participated in a clinical trial in which they received red blood cell transfusions based on a high pretransfusion hematocrit threshold (liberal group) or a low hematocrit threshold (restricted group). These 2 preterm groups were compared with a group of full-term healthy control children.
Setting:
Tertiary care hospital.
Participants:
Magnetic resonance imaging scans for 44 of the original 100 subjects were obtained.
Intervention:
Liberal vs restricted transfusion.
Main Outcome Measures:
Intracranial volume, total brain tissue, total cerebrospinal fluid, cerebral cortex and cerebral white matter volume, subcortical nuclei volume, and cerebellum volume.
Results:
Intracranial volume was substantially smaller in the liberal group compared with controls. Intracranial volume in the restricted group was not different from controls. Whole-cortex volume was not different in either preterm group compared with controls. Cerebral white matter was substantially reduced in both preterm groups, more so for the liberal group. The subcortical nuclei were substantially decreased in volume, equally so for both preterm groups compared with controls. When sex effects were evaluated, the girls in the liberal group had the most significant abnormalities.
Conclusion:
Red blood cell transfusions affected the long-term outcome of premature infants as indicated by reduced brain volumes at 12 years of age for neonates who received transfusions using liberal guidelines.
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