Two-year outcomes following a randomised platelet transfusion trial in preterm infants

Journal article

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: ISRCTN87736839

Authors: Moore, CM; D’Amore, A; Fustolo-Gunnink, S; Hudson, C; Newton, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: Archives of Disease in Childhood. Fetal and Neonatal Edition
• Volume: 108
• Issue: 5
• Pages: fetalneonatal-2022
• Publication date: 2023-02-21
• DOI: 10.1136/archdischild-2022-324915
• EISSN: 1468-2052
• ISSN: 1359-2998
• Language: English
• Keywords: Pediatrics; Physical therapy; Intensive care; Randomized controlled trial; Platelet; Intensive care medicine; Internal medicine; Medicine; Cerebral palsy; Platelet transfusion