Customize your JAMA Network experience by selecting one or more topics from the list below.
Advances in prenatal medicine and neonatal intensive care have resulted in improved survival for preterm infants, in particular for those infants with extremely low birth weight (<1000 g) and those born at the limits of viability (22-25 weeks' gestation). Despite improvements in survival, the incidence of disability in this population has not diminished accordingly.1 A major morbidity for this patient group is neurodevelopmental and behavioral abnormalities.2-8
Understanding the risk factors for abnormal neurodevelopmental outcomes is critical for implementing intervention strategies to improve the outcomes of premature infants. Some of the key risk factors for adverse outcome are biologic factors that are not modifiable following preterm birth: gestational age, birth weight, male sex, and multiple birth.9 However, there are factors with potential impact on developmental outcome that can be targeted for improvement. One important factor is management of the anemia of prematurity, particularly, optimal red blood cell (RBC) transfusion practices. Transfusion of packed red blood cells is a major component of neonatal care of the preterm infant. As many as 95% of extremely low-birth-weight infants will receive at least 1 RBC transfusion, as will up to 80% of preterm infants with birth weights less than 1500 g (very low birth weight), during the first few weeks of life.10-12 Red blood cell transfusions can be prescribed according to liberal or restricted guidelines (ie, with relatively high or low pretransfusion hematocrit values, respectively) with the possibility of undertransfusion or overtransfusion, either of which may have adverse effects.13
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Nopoulos PC, Conrad AL, Bell EF, et al. Long-term Outcome of Brain Structure in Premature Infants: Effects of Liberal vs Restricted Red Blood Cell Transfusions. Arch Pediatr Adolesc Med. 2011;165(5):443–450. doi:https://doi.org/10.1001/archpediatrics.2010.269
Create a personal account or sign in to: