title: Long-term outcome of brain structure in premature infants: effects of liberal vs restricted red blood cell transfusions.
abstract: OBJECTIVE
  To assess the long-term outcome of brain structure in preterm infants, at an average age of 12 years, who received a red blood cell transfusion for anemia of prematurity.
  
  
  METHODS
  As neonates, this cohort of infants participated in a clinical trial in which they received red blood cell transfusions based on a high pretransfusion hematocrit threshold (liberal group) or a low hematocrit threshold (restricted group). These 2 preterm groups were compared with a group of full-term healthy control children.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Magnetic resonance imaging scans for 44 of the original 100 subjects were obtained.
  
  
  METHODS
  Liberal vs restricted transfusion.
  
  
  METHODS
  Intracranial volume, total brain tissue, total cerebrospinal fluid, cerebral cortex and cerebral white matter volume, subcortical nuclei volume, and cerebellum volume.
  
  
  RESULTS
  Intracranial volume was substantially smaller in the liberal group compared with controls. Intracranial volume in the restricted group was not different from controls. Whole-cortex volume was not different in either preterm group compared with controls. Cerebral white matter was substantially reduced in both preterm groups, more so for the liberal group. The subcortical nuclei were substantially decreased in volume, equally so for both preterm groups compared with controls. When sex effects were evaluated, the girls in the liberal group had the most significant abnormalities.
  
  
  CONCLUSIONS
  Red blood cell transfusions affected the long-term outcome of premature infants as indicated by reduced brain volumes at 12 years of age for neonates who received transfusions using liberal guidelines.
authors.affiliation: University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA. peggy-nopoulos@uiowa.edu
authors.forename: Peg C
authors.initials: PC
authors.lastname: Nopoulos
authors.forename: Amy L
authors.initials: AL
authors.lastname: Conrad
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Strauss
authors.forename: John A
authors.initials: JA
authors.lastname: Widness
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Magnotta
authors.forename: M Bridget
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: Michael K
authors.initials: MK
authors.lastname: Georgieff
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lindgren
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Richman
mesh_terms: D000367:Age Factors; D000751:Anemia, Neonatal / Q000175:diagnosis / Q000628:therapy*; D001921:Brain / Q000473:pathology*; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006400:Hematocrit / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012016:Reference Values; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors