School-age neurodevelopmental outcomes after non-emergency red blood cell transfusions in preterm infants: a propensity score–matched study from the Epipage 2 cohort
Abstract
The objective of this study is to evaluate whether non-emergency red blood cell transfusions (RBCT) is associated with neurologic outcomes in preterm infants born at 27-31 weeks of gestation. This analysis used data from the Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE-2), a French nationwide prospective cohort. Infants born at 27-31 weeks and surviving to 5½ years were included, excluding those with emergency RBCT indications. Neurologic outcomes, defined as moderate or severe disabilities, a composite of motor, neurosensory, and cognitive disabilities, were assessed at 5½ years with standardized scales. Behavioral difficulties were evaluated using parental questionnaires. Transfused and non-transfused infants were matched 1:1 using propensity scores. Statistical analyses included odds ratios (ORs) and mean differences. Of the 2182 infants included (656 transfused, 1526 non-transfused), 1062 were matched (531 per group). In the unmatched cohort, RBCT exposure was significantly associated with the composite outcome of moderate to severe neurological disabilities (OR, 1.40; 95%CI, 1.04-1.87). Cognitive impairment and developmental coordination disorders were significantly increased with RBCT (OR, 1.40; 95%CI, 1.07-1.81 and OR, 1.44; 95%CI, 1.06-1.96), respectively. After adjustment using the propensity score, RBCTs were not significantly associated with any individual outcome: cerebral palsy, overall cognitive deficiency, coordination disorders, behavioral difficulties, or moderate-to-severe neurological disabilities. Only the association with cognitive performance relating to working memory persisted (mean difference, -2.3; 95%CI, -4.2 to -0.5). Conclusion: After controlling for potential confounders, non-emergency RBCTs in preterm infants born at 27-31 weeks were not significantly associated with long-term neurologic outcomes but reduced working memory warrants further investigation. Trial registration: NCT03078439.
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BibTeX
@article{coignard2026schoolage,
title = {{School-age neurodevelopmental outcomes after non-emergency red blood cell transfusions in preterm infants: a propensity score–matched study from the Epipage 2 cohort}},
author = {Maxime Coignard and Laetitia Marchand-Martin and Elsa Kermorvant-Duchemin and Gilles Cambonie and Barthélémy Tosello and Pierre-Yves Ancel and Héloïse Torchin and Isabelle Guellec},
journal = {European Journal of Pediatrics},
year = {2026},
month = jun,
doi = {10.1007/s00431-026-07137-5},
url = {https://hal.science/hal-05762611v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - School-age neurodevelopmental outcomes after non-emergency red blood cell transfusions in preterm infants: a propensity score–matched study from the Epipage 2 cohort
AU - Maxime Coignard
AU - Laetitia Marchand-Martin
AU - Elsa Kermorvant-Duchemin
AU - Gilles Cambonie
AU - Barthélémy Tosello
AU - Pierre-Yves Ancel
AU - Héloïse Torchin
AU - Isabelle Guellec
PY - 2026
DA - 2026/06/09
JO - European Journal of Pediatrics
DO - 10.1007/s00431-026-07137-5
UR - https://hal.science/hal-05762611v1
AB - The objective of this study is to evaluate whether non-emergency red blood cell transfusions (RBCT) is associated with neurologic outcomes in preterm infants born at 27-31 weeks of gestation. This analysis used data from the Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE-2), a French nationwide prospective cohort. Infants born at 27-31 weeks and surviving to 5½ years were included, excluding those with emergency RBCT indications. Neurologic outcomes, defined as moderate or severe disabilities, a composite of motor, neurosensory, and cognitive disabilities, were assessed at 5½ years with standardized scales. Behavioral difficulties were evaluated using parental questionnaires. Transfused and non-transfused infants were matched 1:1 using propensity scores. Statistical analyses included odds ratios (ORs) and mean differences. Of the 2182 infants included (656 transfused, 1526 non-transfused), 1062 were matched (531 per group). In the unmatched cohort, RBCT exposure was significantly associated with the composite outcome of moderate to severe neurological disabilities (OR, 1.40; 95%CI, 1.04-1.87). Cognitive impairment and developmental coordination disorders were significantly increased with RBCT (OR, 1.40; 95%CI, 1.07-1.81 and OR, 1.44; 95%CI, 1.06-1.96), respectively. After adjustment using the propensity score, RBCTs were not significantly associated with any individual outcome: cerebral palsy, overall cognitive deficiency, coordination disorders, behavioral difficulties, or moderate-to-severe neurological disabilities. Only the association with cognitive performance relating to working memory persisted (mean difference, -2.3; 95%CI, -4.2 to -0.5). Conclusion: After controlling for potential confounders, non-emergency RBCTs in preterm infants born at 27-31 weeks were not significantly associated with long-term neurologic outcomes but reduced working memory warrants further investigation. Trial registration: NCT03078439.
SN - 0340-6199
SN - 1432-1076
ER -