Gestational Neonates Research Articles

Factors influencing neonatal outcomes in twin pregnancies undergoing cesarean section: a cross-sectional study

This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section. This was a cross-sectional study in a tertiary care referral hospital. The primary outcome was to ascertain the effects of independent factors on the 1st and 5th minute APGAR scores, neonatal intensive care unit admissions, the need for mechanical ventilation, and neonatal mortality. A total of 453 pregnant women and 906 newborns were included in the analysis. The final logistic regression model revealed that early gestational weeks and neonates <3rd weight percentile at the time of delivery were the most significant predictors of all poor outcome parameters in at least one of the twins (p<0.05). General anesthesia for cesarean section was associated with 1st minute APGAR<7 and the need for mechanical ventilation, and emergency surgery was correlated with the need for mechanical ventilation (p<0.05) in at least one of the twins. General anesthesia, emergency surgery, early gestational weeks, and birth weight <3rd weight percentile were strongly associated with poor neonatal outcomes in at least one of the twins delivered by cesarean section.

Perinatal Outcome among Women with Gestational Diabetes Mellitus

Background &amp; Objectives: Diabetes in pregnancy is associated with an increased risk of complications in both the mother and the fetus. Early diagnosis by the screening of pregnant women between 24 to 28 weeks of gestation with proper control of diabetes is important to reduce the adverse effects in perinatal outcomes. This study aims to know the perinatal outcome among neonates of diabetic mothers in comparison with those of non-diabetic mothers. Methods: A case control study was carried out at Maternity Teaching Hospital in Erbil City, Kurdistan Region, Iraq over 6 months’ period, from 1st April 2019 to 1st 0f January 2020. A convenient sample size of 100 participants of diabetic mothers compared with 100 non-diabetic mothers with ? 34 weeks of gestation till one week post-delivery, perinatal outcome including gestational age, mode of delivery, admission to neonatal care unit, birth weight, gender, early neonatal death, intrauterine death, the intrauterine fetal restriction was measured in both groups. Results: Among majority of gestational diabetic mothers regarding to maternal age 33.5% were aged between 18-35 years, 16.5% were older than 35, the most common complications in gestational diabetes group which were statistically significant were hypoglycemia, polycythemia and respiratory distress( 17.5%, 13% and 20% respectively) , neonatal macrosomia were revealed in 22.5% of gestational diabetes mellitus neonates and only 10% in non- gestational diabetes mellitus revealed, Conclusion: Morbidities like hypoglycemia, macrosomia, polycythemia, and respiratory distress syndrome are more common among babies of diabetic mothers when compared to those of non-diabetic mothers, and they are the most common complications that were observed.

Pregnancy and parturition in dromedary camels III. Incidence, timing and factors affecting abortions and perinatal mortality under intensive management

In this study, the incidence, timing and risk factors associated with abortion and perinatal mortality (PM) were described in dromedary camels under intensive management. In addition, overall pregnancy losses were also summarized and weekly risk of pregnancy wastage was determined throughout gestation. Data were collected over 11 breeding seasons from September 2006 through June 2017 at the world's largest camel dairy farm. A total of 229 abortions were observed (5.05%) out of 4533 pregnancies after 60 days (d) of gestation. Most abortions were singleton (n = 199, 86.9%), but twin abortions were also recorded in 30 cases (13.1%). Abortions showed a pronounced seasonal distribution, with a peak in August. The age category (P < 0.01), breed or ecotype of the female (P < 0.05) and bull influenced the occurrence of singleton abortions. Dromedaries with twins tended to abort earlier than those with a singleton fetus (median = 232.5 d vs. 257 d, P = 0.053). Perinatal mortality was observed in 174 cases (3.84%) out of 4533 pregnancies after 60 d of gestation. The condition included the premature birth of non-viable calves after shorter than normal gestation (330–350 d, n = 26, 14.9%), the birth of well-developed but dead calves after normal gestation length (n = 120, 69.0%) and neonates that died within 48 h after delivery (n = 28, 16.1%). The frequency distribution of PM was parallel with that of parturitions. The most important predisposing factor for PM was difficult calving. Thirty-nine percent (68 out of 174) of these losses were associated with dystocia. In addition, age category (P < 0.05) and parity of the female (P < 0.01), month of delivery (P < 0.05) and breeding season (P < 0.05) also affected the incidence of PM. The cause of 60 cases of PM (1.4% of all deliveries) could not be determined and was considered idiopathic. In conclusion, one-third of total pregnancy losses occurred during mid to late gestation. Approximately 10% of pregnancies after Day 60 failed, and 90% resulted in the birth of a live calf that survived beyond 48 h. More than half of these pregnancy losses were abortions before 330 d of gestation, and approximately 40% were classified as PM. The weekly mean risk of pregnancy loss after 100 d of gestation remained only a fraction of that observed during the first 2–3 months.

First-Trimester Normotension Is a Weak Indicator of Normal Maternal Cardiovascular Function.

As by definition, mean arterial pressure equals the product of cardiac output (CO) and total vascular resistance (TPR), we hypothesized that, irrespective of thresholds to define hypertension, a CO-TPR imbalance might exist in first-trimester normotensive pregnancies with altered risks for adverse gestational outcomes. A standard protocol was used for automated blood pressure measurement combined with impedance cardiography assessment of CO and TPR (NICCOMO). First-trimester normotensive pregnant women were categorized into 3 groups relative to the reference 75th percentile (P75) of CO and TPR: (1) normal CO and TPR, (2) high CO, and (3) high TPR. These subgroups were compared at blood pressure thresholds 140/90, 130/85, and 130/80 mmHg. The gestational outcome was categorized after birth according to International Society for Studies of Hypertension in Pregnancy criteria. Compared with pregnancies with normal CO and TPR (≤P75), women with high TPR at blood pressure <140/90 mmHg are at risk for developing gestational hypertension (odds ratio, 3.795 [1.321-10.904]; P<0.010), late-onset preeclampsia (odds ratio, 3.137 [1.060-9.287]; P<0.050), and neonates small for gestational age (odds ratio, 1.780 [1.056-2.998]; P<0.050). Cardiovascular imbalance can present in normotensive women in the first trimester and is associated with increased risks for adverse gestational outcomes. This study illustrates the relevance of CO and TPR assessments as an adjunct to blood pressure measurement and invites for further exploring their value in screening algorithms for gestational hypertensive disorders and/or small for gestational age.

A Prospective, Case-Control Study of Serum Metabolomics in Neonates with Late-Onset Sepsis and Necrotizing Enterocolitis.

Late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) are major causes of neonatal morbidity and mortality. In this prospective, case-control study, we evaluated the metabolic profile of neonates with LOS and NEC. Blood samples were collected from 15 septic neonates and 17 neonates with NEC at the clinical suspicion of the specific diseases. Sixteen gestational and postnatal age-matched neonates without sepsis/NEC served as controls. Serum metabolic profiles were assessed using liquid chromatography–quadrupole time-of-flight mass spectrometry. Metabolomic analysis revealed significant differences in the metabolic profile of neonates with LOS or NEC compared to controls. More specifically, a number of molecules possibly identified as phosphatidylcholines or lysophosphatidylcholines were found to be significantly reduced both in neonates with LOS and those with NEC compared to controls. Additionally, L-carnitine could efficiently discriminate NEC cases from controls. The results of the current study suggest that certain phospholipids and their derivatives could possibly be used as biomarkers for the early detection of LOS and NEC.

Clinical Course of a Case of Elizabethkingia Meningoseptica in a Critical Neonate at a Tertiary Care Hospital in Saudi Arabia

Case Report: In this paper we discuss the clinical course of a 25-week gestational age preterm neonate who suffered with multiple comorbidities atop of an E. meningoseptica infection causing meningitis and hydrocephalus. A multitude of antibiotics were administered to the child, such as vancomycin, ciprofloxacin, trimethoprim-sulfamethoxazole, and rifampicin. However, the pathogen either had prior resistance to the agents or newly developed resistance along the disease course. After many trials of antibiotics, the usage of ceftazidime/avibactam and moxifloxacin dual therapy induced clinical and microbiological eradication of the pathogen. Objective: This case report aims to discuss the multidrug approach used to treat a preterm neonates Elizabethkingia Meningoseptica infection in a Tertiary Care Hospital in Saudi Arabia. Conclusion: E. meningoseptica is an uncommon infectious agent which can cause meningitis and even sepsis that is difficult to treat due to its multidrug resistance phenotype. Continuous reviews of new case reports on successful attempts of treating E. meningoseptica are paramount to maintaining updated therapy options for newly encountered cases in day-to-day practice in the neonatal intensive care unit (NICU).

The impact of shared governance on the adverse mood of parturients with gestational hypertension and perinatal indicators of newborns

This study aimed to investigate the effect of shared governance on the adverse mood of parturients with gestational hypertension and perinatal indicators of newborns. A total of 318 patients with gestational hypertension treated in our hospital were enrolled as study subjects and were divided into a study group (200 cases) and a control group (118 cases) using double-blind, controlled and randomised methods. Before intervention, the systolic blood pressure (SBP), diastolic blood pressure (DBP), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD) and Quality of Life Scale (SF-36) scores did not differ significantly between the two groups (p>.05). After intervention, the study group had lower SBP, DBP, HAMA and HAMD scores and higher SF-36 scores than the control group (p<.05). The neonates in the study group experienced a lower incidence of adverse outcomes than those in the control group (p<.05). Shared governance can regulate blood pressure and improve mood and quality of life in parturients with gestational hypertension. It can also reduce the incidence of adverse events in newborns during the perinatal period. Impact Statement What is already known on this subject? Gestational hypertension is the development of hypertension in pregnant women after 2 or 20 weeks of gestation and is characterised by headache, dizziness, nausea and swelling of the lower legs. Early intervention is key to improving maternal and neonatal prognosis. Shared governance is an emerging model of participatory decision-making in which nurses are empowered to make decisions about clinical practice standards, quality improvement, staff and professional development, and research, aiming to cultivate the patients' sense of responsibility for their health. What do the results of this study add? This study demonstrated that shared governance can regulate maternal blood pressure and improve maternal adverse mood, maternal quality of life and reduce the incidence of perinatal adverse events in the newborn, indicating the potential of shared governance and may promote the clinical application of shared governance. What are the implications of these findings for clinical practice and/or further research? This study starts with adverse mood of parturients and perinatal outcomes of newborns, and demonstrates in detail the impact of shared governance in nursing interventions on parturients with gestational hypertension and neonates. The data are detailed and reliable, providing certain clinical references for follow-up research.

Management of severe hyperbilirubinemia in the cholestatic neonate: a review and an approach.

A review of the literature demonstrates that severe total hyperbilirubinemia (total serum bilirubin≥20 mg/dL [340 µmol/L])in some cholestatic term (≥37 weeks) and late-preterm (≥340/7-366/7 weeks) gestation neonates poses a risk for bilirubin-induced brain damage. When the direct bilirubin fraction is <50% of the total serum bilirubin this risk is associated with the total serum bilirubin alone and treatment decisions should be based on the total serum bilirubin. On the other hand, there are limited data on the risk of bilirubin-induced brain damage in the neonate with severe total hyperbilirubinemia and a direct bilirubin fraction that is equal to or exceeds 50% of the total serum bilirubin. When this rare combination occurs, efforts to keep the indirect bilirubin fraction from reaching severe levels might, nevertheless, be prudent.

Neonatal outcomes of non-vigorous neonates with meconium-stained amniotic fluid before and after change in tracheal suctioning recommendation.

Objective:To evaluate the short-term outcomes of non-vigorous infants born through meconium-stained amniotic fluid (MSAF) before and after implementation of no-tracheal suctioning guidelines.Study design:Single-center retrospective study of ≥36-week gestation neonates with MSAFResults:During routine-suction era (9/2013–12/2014), 280/2306 neonates (12%) were born through MSAF and 39 (14%) were non-vigorous. Thirty (77%) of non-vigorous infants underwent tracheal suctioning. In the no-suction era (1/2017–12/2018), 282/2918 neonates (9.7%) were born through MSAF and 30 (10.6%) were non-vigorous and one needed intubation. Admissions for meconium aspiration syndrome (15% vs 53%) and respiratory distress (18% vs 57%) were significantly higher among non-vigorous infants in the no-suction era.Conclusions:In this single-center study, non-vigorous infants born through MSAF without routine-tracheal suctioning had a higher incidence of NICU admission for MAS and respiratory distress compared to the routine-suction era. Multicenter randomized trials evaluating tracheal suction in non-vigorous infants with MSAF are warranted.

Maternal Serum Copeptin As a Biomarker For Intrauterine Growth Restriction

In obstetrical world, Intrauterine Growth Restriction (IUGR) occupies second slot as a cause of small for gestation neonates, first being premature birth, both of which result in potential neonatal morbidities and mortalities. IUGR is defined as an estimated fetal weight at one point in time at or below 10th percentile for gestational age. Annually about thirty million babies suffer from IUGR and out of these about 75% are Asians. IUGR has been found to be associated with increased levels of Copeptin. As copeptin is a marker of endogenous stress, so increased copeptin levels can indicate fetal and maternal stress in IUGR Objectives: The objectives of this study were to the compare maternal serum copeptin levels in pregnancies with IUGR and pregnancies with adequate for gestational age fetuses and to establish the significance of copeptin as a biomarker for IUGR. Methodology: It was a cross-sectional comparative study in which maternal serum copeptin levels were measured and compared in 60 patients divided in two groups, pregnancies with IUGR and normal pregnancies with adequate for gestation age fetuses between 28-35 weeks of gestation Results: Maternal serum copeptin levels were raised in pregnant women with IUGR as compared to that in pregnant women with adequate for gestational age fetuses. Mean ± SD maternal serum copeptin levels were 97.5 ± 6 pg/ml in pregnant women with AGA fetuses and 121 ± 7.8 pg/ml in pregnant women with IUGR. Conclusions: Maternal serum copeptin levels are raised in pregnancies with IUGR as compared to pregnancies with adequate for age fetuses which can represent as a possible clinical biomarker for identification of IUGR.

Predictors of Mortality in Neonatal Shock: A Retrospective Cohort Study.

To study the incidence, clinical profile, and predictors of mortality in neonatal shock. We enrolled consecutive inborn neonates, who developed shock during hospital stay (between January 1, 2018 to December 31, 2019) at a tertiary-care, research center of northern India. We retrieved the clinical data from our electronic database, case record files, nursing charts, and laboratory investigations from the hospital's Health Information System. Non-survivors were compared with survivors to identify independent predictors of mortality. We had 3,271 neonatal admissions during the study period. We recorded 415 episodes of neonatal shock in 392 neonates [incidence 12.0% (95% confidence interval: 10.9%-13.2%)]. Of 415 episodes, 237 (57%) episodes were identified as septic shock, 67 (16%) episodes as cardiogenic shock, and six (1.4%) episodes as obstructive shock. Remaining 105 (25%) episodes were contributed by more than one etiology of shock. There were 242 non-survivors among 392 neonates with shock (case fatality rate: 62%). On univariate analysis, gestational age, birth weight, incidence of hyaline membrane disease, early-onset sepsis, Acinetobacter sepsis, and cardiogenic shock were significantly different between survivors and non-survivors. Female gender and small for gestational age (SGA) neonates showed a trend of significance. On multivariable regression analysis, we found gestational age, SGA neonates, female gender, and Acinetobacter sepsis to have an independent association with mortality. Septic shock was the commonest cause of neonatal shock at our center. Neonatal shock had very high case fatality rate. Gestational age, SGA, female gender, and Acinetobacter sepsis independently predicted mortality in neonatal shock.

Small for Gestational Age Preterm Neonates Exhibit Defective GH/IGF1 Signaling Pathway.

Objective: To investigate the impact of fetal growth restriction (FGR) on hormonal regulation of post-natal growth and glucose metabolism [via insulin and growth hormone (GH)/Insulin-like Growth factor 1 (IGF1) axis pathways] in small for gestational age (SGA) neonates.Methods: We conducted a monocentric observational prospective comparative study on 73 singleton babies born with a weight inferior to 2,000 g. We analyzed auxological (weight, height and head circumference), and hormonal (GH, IGF1, and insulin plasma concentrations) data comparing SGA and appropriate for gestational age (AGA) neonates, between day 1 and 60.Results: One third (23/73) of the neonates were SGA. Twenty-five percent (18/73) required insulin for idiopathic hyperglycemia of prematurity and were smaller in weight and head circumference at discharge. In the SGA group compared with the AGA group, GH plasma concentrations were higher at day 3 (70.1 vs. 38.0 mIU/L) and IGF1 plasma concentrations were higher at day 10 (29.0 vs. 18.7 ng/ml).Conclusions: SGA neonates displayed resistance to GH and IGF1, concomitant to insulin resistance. This could partially explain the initial defective catch-up growth and, later in life, the higher prevalence of metabolic syndrome in this population.

Extremely preterm infant weighing 350 g: too small to survive?

Every year around 15 million premature neonates are born in the world, and this number is continuously increasing. The incidence of premature birth varies between 5% and 18% throughout the world. Despite advancements in medicine and technology and increased evidence-based diagnostic and treatment recommendations, prematurity is the most common cause of death among children under 5 years of age. The sequelae in the survivors of extreme prematurity are mental disability, cognitive impairment, cerebral palsy, blindness, deafness and chronic illness. Considering ethical and economic implications, neonatal survival and morbidity prognosis, resuscitation of neonates of borderline gestation differs in various countries and many international organisations do not recommend active resuscitation and treatment of newborns of up to 25 weeks of gestation. We present a case study of one of the smallest newborns in the world and the smallest newborn known to survive in Lithuania.

Characteristics of neonatal late onset sepsis in Sanglah Hospital, Bali

Neonatal Late-Onset Sepsis (LOS) is a leading cause of mortality in the Neonatal Intensive Care Unit (NICU). The microbial characteristics of LOS are of primary importance in guiding clinical antisepsis practice, and strategies to prevent and treat neonatal LOS, in turn, influence the pattern of LOS pathogens. This study is a retrospective descriptive study with a cross-sectional approach conducted between 2016 until 2020 in the neonatal ward (level II-III) of the Sanglah General Hospital, Bali. Data collected consists of demography, clinical characteristics, laboratory results, and outcomes. Subjects in this study dominated by male (64%), gestational age &gt; 37 weeks (56%), born ≥ 2.500 grams (54%), last mother education mostly in Senior High School (56%), spontaneous delivery method (54%) and 31 (62%) subjects were referral from other hospital and primary health care. Most of the subjects were lethargic (68%) and 15 (30%) subjects were died. Laboratory finding normal leukocyte, neutrophil, lymphocyte, hemoglobin, thrombocyte and IT ratio but have higher procalcitonin result. Poor outcome group were dominated by male, smaller gestational age, VLBW, and neonates who experience lethargy, temperature instability, respiratory distress and got positive blood culture.

21q22.11q22.12 deletion syndrome with secondary hemophagocytic lymphohistiocytosis

Haemophagocyticy lymyphohistiocytosis in the new-born is uncommon. Incidence is reported between 1 in 50,000 to 1,50,000 admissions. Usually it is primary or familial HLH in the first year of life. Secondary causes are due to viral, bacterial and fungal infections. A dysmorphic small for gestational age male neonate presented with sepsis and neonatal cholestasis. He also had associated HLH. Exom sequencing showed a 21q22.11q22.12 deletion. This has not known to have any association with familial HLH. He was managed with IVIG and steroids. The neonate made a recovery but succumbed later to an intercurrent illness.

A New Hour-Specific Serum Bilirubin Nomogram for Neonates ≥35 Weeks of Gestation

To develop a statistically rigorous, hour-specific bilirubin nomogram for newborns based on a very large data set; and use it prospectively as a replacement for the 1999 Bhutani nomogram. This was a retrospective analysis of first total serum bilirubin (TSB) measurements from 15years of universal bilirubin screening during birth hospitalizations at 20 Intermountain Healthcare hospitals. Hour-specific TSB values were assembled into a nomogram by percentile, and subgroups were compared. The information obtained included robust data in the first 12hours after birth (which was not included in the 1999 nomogram), general agreement with the 1999 nomogram for values in the first 60hours, but higher 75th and 95th percentile TSB values thereafter in the new version, no difference in TSB between male and female infants, higher TSB values among earlier gestation neonates (350/7-366/7weeks vs ≥37weeks, P<.0001), and lower TSB values in neonates of Black race (P<.0001) and higher values in neonates of Asian race (P<.001). An updated and more informative Bhutani neonatal bilirubin nomogram, based on 140 times the number of subjects included the 1999 version, is now in place in our health care system.

Transfusions and neurodevelopmental outcomes in extremely low gestation neonates: to transfuse or not to transfuse, that is the question….

Transfusions and neurodevelopmental outcomes in extremely low gestation neonates: to transfuse or not to transfuse, that is the question….

Effect of gestational age and postnatal age on the endothelial glycocalyx in neonates

Prematurity predisposes to cardiovascular disease; however the underlying mechanisms remain elusive. Disturbance of the endothelial glycocalyx (EG), an important regulator of vessel function, is thought to contribute to vascular pathology. Here, we studied the EG with respect to gestational and postnatal age in preterm and term neonates. The Perfused Boundary Region (PBR), an inverse measure of glycocalyx thickness, was measured postnatally in 85 term and 39 preterm neonates. Preterm neonates were further analyzed in two subgroups i.e., neonates born < 30 weeks gestational age (group A) and neonates born ≥ 30 weeks (group B). In preterm neonates, weekly follow-up measurements were performed if possible. PBR differed significantly between preterm and term neonates with lowest values representing largest EG dimension in extremely premature infants possibly reflecting its importance in fetal vascular development. Linear regression revealed a dependence of PBR on both, gestational age and postnatal age. Furthermore, hematocrit predicted longitudinal PBR changes. PBR measured in group A at a corrected age of > 30 weeks was significantly higher than in group B at birth, pointing towards an alteration of intrinsic maturational effects by extrinsic factors. These changes might contribute to the increased cardiovascular risk associated with extreme prematurity.

The Utility of the Neutrophil-Lymphocyte Ratio as an Early Diagnostic Marker in Neonatal Sepsis.

AimTo find the diagnostic utility of the neutrophil to lymphocyte ratio (NLR) in the early diagnosis of neonatal sepsis.MethodologyThe case records of all blood culture-positive septic neonates admitted from January 2018 to December 2018 were reviewed. Total leucocyte count, absolute neutrophil count, absolute lymphocyte counts, NLR, and C-reactive protein (CRP) of septic neonates were compared with gestational age-matched nonseptic neonates by an unpaired t-test. The diagnostic performance of NLR and CRP was analyzed by receiver operating characteristic (ROC) analysis.ResultA total of 41 blood culture-positive neonates and 52 nonseptic neonates were enrolled in this study. There was no significant difference in the total leucocyte count and absolute neutrophil counts of septic and nonseptic neonates. The mean absolute lymphocyte count of septic neonates (2795±1424/cumm) was significantly lower than that of nonseptic neonates (4449±1794/cumm; p=<0.001). The mean NLR of septic neonates (3.88±1.78) was significantly higher as compared to nonseptic (2.3404 ±1.98) neonates (p=0.045). For the diagnosis of sepsis, NLR at cutoff >1.7 had a sensitivity and specificity of 68.3% and 46.2%, respectively; CRP at cutoff >6 mg/dl had sensitivity and specificity of 78.05% and 92.31%, respectively. In the ROC analysis, the area under the curve (AUC) for CRP and NLR for the diagnosis of neonatal sepsis was 0.918 (p=<0.001) and 0.623 (p=0.042), respectively.ConclusionBlood culture-positive septic neonates had significantly higher NLR as compared to nonseptic neonates. However, when compared to CRP, NLR was not found to be a better predictor of sepsis in our study.

Transfusions and neurodevelopmental outcomes in extremely low gestation neonates enrolled in the PENUT Trial: a randomized clinical trial.

BackgroundOutcomes of extremely low gestational age neonates (ELGANs) may be adversely impacted by packed red blood cell (pRBC) transfusions. We investigated the impact of transfusions on neurodevelopmental outcome in the Preterm Erythropoietin (Epo) Neuroprotection (PENUT) Trial population.MethodsThis is a post hoc analysis of 936 infants 24-0/6 to 27-6/7 weeks’ gestation enrolled in the PENUT Trial. Epo 1000 U/kg or placebo was given every 48 h × 6 doses, followed by 400 U/kg or sham injections 3 times a week through 32 weeks postmenstrual age. Six hundred and twenty-eight (315 placebo, 313 Epo) survived and were assessed at 2 years of age. We evaluated associations between BSID-III scores and the number and volume of pRBC transfusions.ResultsEach transfusion was associated with a decrease in mean cognitive score of 0.96 (95% CI of [−1.34, −0.57]), a decrease in mean motor score of 1.51 (−1.91, −1.12), and a decrease in mean language score of 1.10 (−1.54, −0.66). Significant negative associations between BSID-III score and transfusion volume and donor exposure were observed in the placebo group but not in the Epo group.ConclusionsTransfusions in ELGANs were associated with worse outcomes. We speculate that strategies to minimize the need for transfusions may improve outcomes.Impact Transfusion number, volume, and donor exposure in the neonatal period are associated with worse neurodevelopmental (ND) outcome at 2 years of age, as assessed by the Bayley Infant Scales of Development, Third Edition (BSID-III).The impact of neonatal packed red blood cell transfusions on the neurodevelopmental outcome of preterm infants is unknown.We speculate that strategies to minimize the need for transfusions may improve neurodevelopmental outcomes.