1. Two-year outcomes following a randomised platelet transfusion trial in preterm infants
- Author
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Carmel Maria Moore, Angela D’Amore, Suzanne Fustolo-Gunnink, Cara Hudson, Alice Newton, Beatriz Lopez Santamaria, Alison Deary, Renate Hodge, Valerie Hopkins, Ana Mora, Charlotte Llewelyn, Vidheya Venkatesh, Rizwan Khan, Karen Willoughby, Wes Onland, Karin Fijnvandraat, Helen V New, Paul Clarke, Enrico Lopriore, Timothy Watts, Simon Stanworth, Anna Curley, Neonatology, ARD - Amsterdam Reproduction and Development, Landsteiner Laboratory, Paediatric Haematology, and AII - Infectious diseases
- Subjects
Intensive Care Units ,Child Development ,Intensive Care Units, Neonatal ,Neonatal ,Pediatrics, Perinatology and Child Health ,Obstetrics and Gynecology ,General Medicine ,Neonatology - Abstract
Objective Assess mortality and neurodevelopmental outcomes at 2 years of corrected age in children who participated in the PlaNeT-2/MATISSE (Platelets for Neonatal Transfusion - 2/Management of Thrombocytopenia in Special Subgroup) study, which reported that a higher platelet transfusion threshold was associated with significantly increased mortality or major bleeding compared to a lower one. Design Randomised clinical trial, enrolling from June 2011 to August 2017. Follow-up was complete by January 2020. Caregivers were not blinded; however, outcome assessors were blinded to treatment group. Setting 43 level II/III/IV neonatal intensive care units (NICUs) across UK, Netherlands and Ireland. Patients 660 infants born at less than 34 weeks’ gestation with platelet counts less than 50×109/L. Interventions Infants were randomised to undergo a platelet transfusion at platelet count thresholds of 50×109/L (higher threshold group) or 25×109/L (lower threshold group). Main outcomes measures Our prespecified long-term follow-up outcome was a composite of death or neurodevelopmental impairment (developmental delay, cerebral palsy, seizure disorder, profound hearing or vision loss) at 2 years of corrected age. Results Follow-up data were available for 601 of 653 (92%) eligible participants. Of the 296 infants assigned to the higher threshold group, 147 (50%) died or survived with neurodevelopmental impairment, as compared with 120 (39%) of 305 infants assigned to the lower threshold group (OR 1.54, 95% CI 1.09 to 2.17, p=0.017). Conclusions Infants randomised to a higher platelet transfusion threshold of 50×109/L compared with 25×109/L had a higher rate of death or significant neurodevelopmental impairment at a corrected age of 2 years. This further supports evidence of harm caused by high prophylactic platelet transfusion thresholds in preterm infants. Trial registration number NCT87736839.
- Published
- 2023