PRETERM TRANSFUSIONS: BRAIN FUNCTION/STRUCTURE OUTCOMES

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Red Blood Cell (RBC) transfusion management includes the crucial issue of what are the optimal criteria to determine when transfusion should occur in preterm very-low-birth-weight (VLBW) infants. There is controversy regarding whether more restrictive or more liberal criteria would best serve the long-term outcomes of these infants. In particular, the brain of VLBW infants are especially susceptible to ischemia and hypoxemia, thus the issue of liberal versus restrictive transfusion is particularly important in regard to short and long-term effects on the developing brain. The current proposal plans to address this issue by conducting a long-term outcome evaluation, examining differences in brain structure (using MRI) and function (using cognitive, motor, and behavioral tests) in three groups of 12 year old children: two preterm groups who, at birth, had been randomly assigned to either restrictive or liberal criteria for RBC transfusion during infancy, and a control group of healthy full-term children. Evaluation of the two preterm groups after the transfusion protocol indicated that the restrictive transfusion group suffered a greater incidence of intraventricular hemorrhage, periventricular leukomalacia, or both as seen on ultrasound. These findings suggested that liberal transfusion practices may in fact be "neuroprotective". These infants are now approaching 12 years of age and present an excellent opportunity for long-term assessment, given the ability to address this issue in far greater detail by using the state of the art quantitative imaging methodology and careful functional assessment. By identifying factors that may have a direct influence on the outcome of brain structure and function in children born prematurely, this study has the potential for significantly improving that outcome.