Neonatal ECMO: Neuroimaging and neurodevelopmental outcome
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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