German Kendell, Wood Thomas R, Gogcu Semsa, Heagerty Patrick J, Mayock Dennis E, Comstock Bryan A, Puia-Dumitrescu Mihai, Kolnik Sarah, Mietzsch Ulrike, Law Janessa, Perez Krystle, Valentine Gregory, Bammler Theo K, Juul Sandra E
University of Washington, Department of Pediatrics, Seattle, WA, USA.
Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Pediatr Res. 2025 Jun 2. doi: 10.1038/s41390-025-04149-z.
Packed red blood cell (pRBC) transfusions are often required in extremely premature infants but are associated with increased pro-inflammatory cytokines and adverse neurodevelopment, which may differ by sex.
In this post-hoc analysis of the Preterm Erythropoietin Neuroprotection (PENUT) Trial, associations between pRBC transfusion volume and cytokines at 0-7 and 7-14 days, MRI injury, and Bayley Scales of Infant Development (BSID-III) scores at 24 months corrected age were evaluated. Graphical network and generalized estimating equation models were used to examine interactions by sex as well as the influence of hematocrit level.
182 and 164 infants were assessed with biomarkers at 0-7 and 7-14 days, 220 infants had MRIs, and 692 infants had at least one BSID-III assessment. Infant sex modified the association between pRBC transfusion volume and IL-6 at 7-14 days but did not impact the association between transfusion volume or hematocrit and BSID-III scores. Total pRBC transfusion volume was significantly negatively associated with all BSID-III subscales after accounting for anemia and severity of illness.
Infant sex may impact short-term cytokine responses to transfusions but not the association between transfusion volume and long-term outcomes.
In a post hoc analysis of extremely preterm infants from the PENUT Trial, the relationship between transfusion exposure and pro-inflammatory cytokines, MRI scores and neurodevelopment were evaluated by sex. The impact of transfusions on inflammatory cytokines may vary by sex. However, this does not appear to lead to differences in neurodevelopmental outcomes. Based on current evidence, providers should not alter their transfusion practices based on sex of the infant.
极低出生体重儿常需要输注浓缩红细胞（pRBC），但这与促炎细胞因子增加及不良神经发育有关，且这种关联可能存在性别差异。
在这项对早产儿促红细胞生成素神经保护（PENUT）试验的事后分析中，评估了0至7天和7至14天时pRBC输注量与细胞因子之间的关联、MRI损伤以及24个月矫正年龄时的贝利婴儿发育量表（BSID-III）评分。使用图形网络和广义估计方程模型来检验性别间的相互作用以及血细胞比容水平的影响。
182名和164名婴儿分别在0至7天和7至14天时接受了生物标志物评估，220名婴儿进行了MRI检查，692名婴儿至少进行了一次BSID-III评估。婴儿性别改变了7至14天时pRBC输注量与IL-6之间的关联，但不影响输注量或血细胞比容与BSID-III评分之间的关联。在考虑贫血和疾病严重程度后，pRBC总输注量与所有BSID-III子量表均呈显著负相关。
婴儿性别可能影响输血后的短期细胞因子反应，但不影响输注量与长期结局之间的关联。
在对PENUT试验中极低出生体重儿的事后分析中，按性别评估了输血暴露与促炎细胞因子、MRI评分和神经发育之间的关系。输血对炎性细胞因子的影响可能因性别而异。然而，这似乎并未导致神经发育结局的差异。基于现有证据，医疗服务提供者不应根据婴儿性别改变输血做法。
