Presbyterian Medical Group, Pediatrics, Albuquerque, NM, USA.
Iterative Consulting, Albuquerque, NM, USA.
J Perinatol. 2021 Jun;41(6):1412-1418. doi: 10.1038/s41372-021-00997-9. Epub 2021 Apr 28.
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).
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).
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.
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.
早产儿经常需要接受红细胞输血治疗；然而，输血对认知的影响尚不清楚。我们评估了接受促红细胞生成素刺激剂（ESA）随机试验的早产儿中输血与认知结局之间的关系。
早产儿在住院期间被随机分配接受 ESA 或安慰剂治疗，并记录输血情况。在 18-22 个月（56 例 ESA，24 例安慰剂）和 3.5-4 岁（39 例 ESA，14 例安慰剂）时，使用标准认知发育测试对儿童进行评估。
18-22 个月时的认知评分与输血量呈负相关（p=0.02）。在接受≥1 次输血的患儿中，ESA 治疗组的认知评分显著更高（p=0.003）。在 3.5-4 岁时，输血与认知评分无关。
在安慰剂组中，与未输血的患儿相比，接受输血的患儿在 18-22 个月时的认知评分更低。在 ESA 组中，输血状态与认知评分无差异，提示 ESA 可能具有神经保护作用。
