Elsevier

Seminars in Perinatology

Volume 29, Issue 1, February 2005, Pages 58-65
Seminars in Perinatology

Neonatal ECMO: Neuroimaging and neurodevelopmental outcome

https://doi.org/10.1053/j.semperi.2005.02.009Get rights and content

Intracranial injury continues to be a major complication associated with extracorporeal membrane oxygenation (ECMO)-treated neonates. The reported frequency of abnormal neuroimaging has ranged from 28% to 52%, depending on neuroimaging techniques and methods of classification. The purpose of this chapter is to describe types of imaging techniques commonly used to evaluate the ECMO neonate, to specify different types of injuries that have been reported, and to identify factors which increase the risk of injury. We will then describe the functional impact at age 5 years following neonatal brain injury among ECMO infants.

Section snippets

Risk factors

Multiple factors increase the risk of intracranial injury in infants undergoing extracorporeal membrane oxygenation (ECMO).1, 2, 3, 4, 5, 6 In addition to the necessity for anticoagulant use during bypass, all candidates for ECMO have suffered from hypoxemia and acidosis, many with evidence of vasomotor shock. Hypercarbia, volume expansion, pneumothoraces, and blood pressure fluctuations alter cerebral blood flow.1, 7 Hypotension before or during ECMO may result in cerebral ischemia. Using near

Ultrasound

Ultrasound is particularly useful in the evaluation of infants on ECMO due to its portability and lack of ionizing radiation. The presence of a large intracranial hemorrhage is a contraindication for ECMO initiation, thus a screening examination before cannulation is critical in the assessment of potential therapeutic options. Ultrasound has been sensitive in the evaluation of large cranial hemorrhages. In a series by Bulas and coworkers, sonography successfully identified 46 (94%) of 49 major

Neurodevelopmental impact of perinatal brain injury

Given the relatively high rate of neuroimaging abnormality among ECMO-treated neonates, neurodevelopmental outcome studies have been important in defining the functional impact. Substantial outcomes research in other populations following perinatal brain injury underscores both neurospecificity and neuroplasticity in the young developing brain. Earlier studies of neuroimaging and outcome in the preterm infant serve as an important model for the ECMO-treated neonate. The introduction of routine

Summary

ECMO-treated neonates incur a relatively high frequency of abnormalities identified on routine neuroimaging, which vary widely in type and severity. Multiple risk factors are present before and during cannulation which primarily affect cerebral blood flow. Brain injury severity identified in the neonatal period is predictive of neuropsychological status at age 5 years. Even those children with apparently mild degrees of injury appear to have some increased risk for neuropsychological deficits

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