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

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.