PMID- 38261320 OWN - NLM STAT- MEDLINE DCOM- 20240124 LR - 20240314 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 7 IP - 1 DP - 2024 Jan 2 TI - Platelet Transfusion and Death or Neurodevelopmental Impairment in Children Born Extremely Preterm. PG - e2352394 LID - 10.1001/jamanetworkopen.2023.52394 [doi] LID - e2352394 AB - IMPORTANCE: Infants born extremely preterm receive transfusions at higher platelet count thresholds than older children and adults due to concerns for intracranial hemorrhage. A recent randomized trial comparing 2 platelet transfusion thresholds showed the higher threshold was associated with increased risk of long-term adverse neurodevelopmental outcomes. OBJECTIVE: To evaluate the association of platelet transfusion exposure with death and severe neurodevelopmental impairment (NDI) at 2 years' corrected age in a cohort of infants born extremely preterm. DESIGN, SETTING, AND PARTICIPANTS: An observational cohort study and secondary analysis of the Preterm Erythropoietin Neuroprotection Trial, a randomized, placebo-controlled clinical trial of erythropoietin neuroprotection in neonates born extremely preterm, was conducted in 30 neonatal intensive care units in the US from December 1, 2013, to September 31, 2016. This analysis included 819 infants born extremely preterm at 24 to 27 completed weeks of gestation who had a documented outcome (death or neurodevelopmental assessment). Analysis was performed in April 2023. EXPOSURES: Any platelet transfusion during neonatal intensive care unit hospitalization. MAIN OUTCOMES AND MEASURES: The primary composite outcome was death or severe NDI evaluated at 2 years' corrected age using the Bayley Scales of Infant Development-Third Edition (BSID-III) and the Gross Motor Function Classification System and was defined as the presence of severe cerebral palsy or a BSID-III composite motor or cognitive score 2 SDs below the mean. Confounding by indication for platelet transfusion was addressed with covariate adjustment and propensity score methods. RESULTS: Of the 819 infants included in the analysis (429 [52.4%] male; mean [SD] gestational age, 25.5 [1.1] weeks), 245 (30.0%) received at least 1 platelet transfusion during their initial hospitalization. The primary outcome occurred in 46.5% (114 of 245) of infants exposed to a platelet transfusion and 13.9% (80 of 574) of nonexposed infants with a corresponding odds ratio of 2.43 (95% CI, 1.24-4.76), adjusted for propensity score, gestational age at birth, and trial treatment group. The individual components of death and severe NDI were directionally consistent with the overall composite outcome. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that platelet transfusion in infants born extremely preterm may be associated with an increased risk of death or severe NDI at 2 years' corrected age, although the possibility of residual confounding by indication cannot be excluded. FAU - Davenport, Patricia E AU - Davenport PE AD - Division of Newborn Medicine, Boston Childrens Hospital, Boston, Massachusetts. FAU - Wood, Thomas R AU - Wood TR AD - Division of Neonatology, University of Washington, Seattle. AD - Institute on Human Development and Disability, University of Washington, Seattle. FAU - Heagerty, Patrick J AU - Heagerty PJ AD - Department of Biostatistics, University of Washington, Seattle. FAU - Sola-Visner, Martha C AU - Sola-Visner MC AD - Division of Newborn Medicine, Boston Childrens Hospital, Boston, Massachusetts. FAU - Juul, Sandra E AU - Juul SE AD - Division of Neonatology, University of Washington, Seattle. AD - Institute on Human Development and Disability, University of Washington, Seattle. FAU - Patel, Ravi M AU - Patel RM AD - Department of Pediatrics, Emory University School of Medicine and Childrens Healthcare of Atlanta, Atlanta, Georgia. LA - eng GR - K99 HL156051/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Observational Study DEP - 20240102 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 RN - 11096-26-7 (Erythropoietin) SB - IM MH - Female MH - Humans MH - Infant, Newborn MH - Male MH - *Cerebral Palsy MH - *Erythropoietin MH - Gestational Age MH - Infant, Extremely Premature MH - Platelet Transfusion MH - Randomized Controlled Trials as Topic PMC - PMC10807258 COIS- Conflict of Interest Disclosures: Dr Davenport reported receiving funding from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. Dr Heagerty reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Sola-Visner reported receiving grants from the NHLBI during the conduct of the study and consultant fees from Johnson and Johnson outside the submitted work. Dr Juul reported receiving grants from the NIH during the conduct of the study. Dr Patel reported receiving grants from the NIH outside the submitted work. No other disclosures were reported. EDAT- 2024/01/23 12:42 MHDA- 2024/01/24 06:43 PMCR- 2024/01/23 CRDT- 2024/01/23 11:33 PHST- 2024/01/24 06:43 [medline] PHST- 2024/01/23 12:42 [pubmed] PHST- 2024/01/23 11:33 [entrez] PHST- 2024/01/23 00:00 [pmc-release] AID - 2814212 [pii] AID - zoi231535 [pii] AID - 10.1001/jamanetworkopen.2023.52394 [doi] PST - epublish SO - JAMA Netw Open. 2024 Jan 2;7(1):e2352394. doi: 10.1001/jamanetworkopen.2023.52394.