Association of blood component transfusions with neurodevelopmental impairment in preterm infants by gestational age

Transfusion is frequently prescribed for preterm infants and known to be associated with adverse outcomes. We evaluated the association between transfusions of red blood cells (RBCs), platelets, and plasma in preterm infants and neurodevelopmental impairment (NDI).

This retrospective cohort study included 706 preterm infants. The primary outcome was severe NDI diagnosed at 18-30 months of corrected age. After adjusting, weighted logistic regression was performed to evaluate the associations between each transfusion type, the number of transfusions, and severe NDI.

RBC transfusions were associated with severe NDI in both subgroups (<32 weeks: adjusted odds ratio [aOR] 2.47; 95% confidence interval [CI] 1.13-5.44; ≥32 weeks: aOR 8.13; 95% CI 3.39-19.52). Platelet transfusions were associated with severe NDI in the <32-week group (aOR 2.53; 95% CI 1.26-5.08) but not in the ≥32-week group (aOR 1.20; 95% CI 0.10-14.17). Plasma transfusions were associated with severe NDI in the ≥32-week group (aOR 2.69; 95% CI 1.38-5.24) but not in the <32-week group (aOR 1.19; 95% CI 0.58-2.42).

Transfusions may be associated with severe NDI risk in preterm infants, and this association may differ according to the type of blood product and gestational age at birth.

In addition to RBC and platelet, plasma transfusions are also linked to a higher risk of NDI by two years of corrected age. The association between transfusions and NDI varies by type of blood product and gestational age, with RBC and plasma transfusions posing a greater risk closer to term. Transfusions should be minimized by considering the differing risks based on blood product and gestational age, and further studies are warranted to explore the newly identified association between plasma transfusions and NDI.