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.

Figure 1

Mean Intelligence and Reading Achievement Scores and Confidence Intervals for each Transfusion Group.

Figure 2

Mean z-Scores and Confidence Intervals on Neurocognitive Tests for each Transfusion Group.