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Effect of blood transfusions on cognitive development in very low birth weight infants

Journal of Perinatology volume 41, pages 1412–1418 (2021)Cite this article

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Abstract

Objective

Preterm infants frequently receive red cell transfusions; however, the effect of transfusions on cognition is unclear. We evaluated the relationship between transfusions and cognitive outcomes in preterm infants enrolled in a randomized trial of erythropoiesis stimulating agents (ESAs).

Study design

Preterm infants were randomized to ESAs or placebo during initial hospitalization, and transfusions recorded. Children were evaluated using standard developmental tests of cognition at 18–22 months (56 ESA, 24 placebo) and 3.5–4 years (39 ESA, 14 placebo).

Results

Cognitive scores at 18–22 months were inversely correlated with transfusion volume (p = 0.02). Among those receiving ≥1 transfusion, cognitive scores were significantly higher in the ESA-treated group (p = 0.003). At 3.5–4 years, transfusions were not correlated with cognitive scores.

Conclusions

In the placebo group, transfused children had lower cognitive scores than did non-transfused children at 18–22 months. In the ESA group, cognitive scores did not differ by transfusion status, suggesting ESAs might provide neuroprotection.

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Fig. 1: Subject flow diagram.
Fig. 2: Relationship between BSID-III composite cognitive scores and transfusions.
Fig. 3: 18-22 month cognitive and language scores in non-transfused and transfused infants.
Fig. 4: Comparison of WPPSI-III Full-Scale IQ (FSIQ) scores at the 3.5–4 year follow-up period between ESA-treated and placebo-treated infants; grouped by receiving either no transfusions or ≥1 transfusion.

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Acknowledgements

The authors wish to thank the research coordinators and bedside nurses involved in the original randomized study. We also wish to thank Sarah Peceny and Sean Gonzales for subject coordination, and Michael Steffen, Ron Yeo, and Richard Campbell for developmental follow-up and statistical assistance. We are indebted to the parents for their willingness to allow their children to participate in this study. Finally, we wish to acknowledge US taxpayers for providing the funding to support the National Institutes of Health and this study.

Funding

Supported by grants from the NIH NICHD (R01 HD059856), the University of New Mexico Clinical Translational Science Center (UL1 TR000041), the University of Utah Center for Clinical and Translational Sciences (UL1TR001067), Thrasher Research Fund, and the University of New Mexico Department of Pediatrics.

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Authors and Affiliations

  1. Presbyterian Medical Group, Pediatrics, Albuquerque, NM, USA

    Priya Shah

  2. Iterative Consulting, Albuquerque, NM, USA

    Daniel C. Cannon

  3. Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA

    Jean R. Lowe

  4. Mind Research Network, Albuquerque, NM, USA

    John Phillips

  5. Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Robert D. Christensen, Susan Wiedmeier, Sarah Winter & Robin K. Ohls

  6. American Academy of Pediatrics, Itasca, IL, USA

    Beena Kamath-Rayne

  7. University of Colorado, Aurora, CO, USA

    Adam Rosenberg

  8. MEDNAX, Seattle, WA, USA

    Shrena Patel

  9. CCTS, University of Utah, Salt Lake City, UT, USA

    Shawna Baker

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  1. Priya Shah
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Correspondence to Robin K. Ohls.

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Shah, P., Cannon, D.C., Lowe, J.R. et al. Effect of blood transfusions on cognitive development in very low birth weight infants. J Perinatol 41, 1412–1418 (2021). https://doi.org/10.1038/s41372-021-00997-9

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