Division of Neonatology, Children's National Hospital, Washington, District of Columbia.
Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia.
Am J Perinatol. 2021 Dec;38(14):1557-1564. doi: 10.1055/s-0040-1714208. Epub 2020 Jul 16.
This study aimed to assess the association of clinical risk factors with severity of magnetic resonance imaging (MRI) brain injury in neonatal extracorporeal membrane oxygenation (ECMO) patients.
This is a single-center retrospective study conducted at an outborn level IV neonatal intensive care unit in a free-standing academic children's hospital. Clinical and MRI data from neonates treated with ECMO between 2005 and 2015 were reviewed. MRI injury was graded by two radiologists according to a modified scoring system that assesses parenchymal injury, extra-axial hemorrhage, and cerebrospinal fluid spaces. MRI severity was classified as none (score = 0), mild/moderate (score = 1-13.5), and severe (score ≥ 14). The relationship between selected risk factors and MRI severity was assessed by Chi-square, analysis of variance, and Kruskal-Wallis tests where appropriate. Combinative predictive ability of significant risk factors was assessed by logistic regression analyses.
MRI data were assessed in 81 neonates treated with ECMO. Veno-arterial (VA) patients had more severe injury compared with veno-venous patients. There was a trend toward less severe injury over time. After controlling for covariates, duration of ECMO remained significantly associated with brain injury, and the risk for severe injury was significantly increased in patients on ECMO beyond 210 hours.
Risk for brain injury is increased with VA ECMO and with longer duration of ECMO. Improvements in care may be leading to decreasing incidence of brain injury in neonatal ECMO patients.
· Veno-arterial ECMO is associated with more brain injury by MRI compared with veno-venous ECMO.. · Longer duration of ECMO is significantly associated with severe brain injury by MRI.. · Risk for neurologic injury may be decreasing over time with advances in neonatal ECMO..
本研究旨在评估临床危险因素与新生儿体外膜肺氧合（ECMO）患者磁共振成像（MRI）脑损伤严重程度的关系。
这是一项在一家独立的学术儿童医院的外生四级新生儿重症监护病房进行的单中心回顾性研究。回顾了 2005 年至 2015 年期间接受 ECMO 治疗的新生儿的临床和 MRI 数据。两位放射科医生根据改良评分系统评估实质损伤、脑外出血和脑脊液间隙，对 MRI 损伤进行分级。MRI 严重程度分为无损伤（评分=0）、轻度/中度（评分=1-13.5）和重度（评分≥14）。采用卡方检验、方差分析和 Kruskal-Wallis 检验（视情况而定）评估选定危险因素与 MRI 严重程度之间的关系。采用逻辑回归分析评估有意义的危险因素的综合预测能力。
评估了 81 例接受 ECMO 治疗的新生儿的 MRI 数据。与静脉-静脉患者相比，静脉-动脉（VA）患者的损伤更严重。随着时间的推移，损伤程度呈下降趋势。在控制协变量后，ECMO 持续时间与脑损伤仍显著相关，ECMO 持续时间超过 210 小时的患者发生严重损伤的风险显著增加。
VA-ECMO 和 ECMO 持续时间延长与脑损伤风险增加有关。新生儿 ECMO 患者的脑损伤发生率可能因护理的改进而降低。
·VA-ECMO 与静脉-静脉 ECMO 相比，MRI 显示脑损伤更严重。·ECMO 持续时间较长与 MRI 显示的严重脑损伤显著相关。·随着新生儿 ECMO 技术的进步，神经损伤的风险可能会随着时间的推移而降低。
