title: Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data.
abstract: BACKGROUND
  Neurologic complications in neonates supported with extracorporeal membrane oxygenation (ECMO) are common and diminish their quality of life and survival. An understanding of factors associated with neurologic complications in neonatal ECMO is lacking. The goals of this study were to describe the epidemiology and factors associated with neurologic complications in neonatal ECMO.
  
  
  METHODS
  Retrospective cohort study of neonates (age ≤30 days) supported with ECMO using data reported to the Extracorporeal Life Support Organization during 2005-2010.
  
  
  RESULTS
  Of 7,190 neonates supported with ECMO, 1,412 (20 %) had neurologic complications. Birth weight <3 kg [odds ratio (OR): 1.3; 95 % confidence intervals (CI): 1.1-1.5], gestational age (<34 weeks; OR 1.5, 95 % CI 1.1-2.0 and 34-36 weeks: OR 1.4, 95 % CI 1.1-1.7), need for cardiopulmonary resuscitation prior to ECMO (OR 1.7, 95 % CI 1.5-2.0), pre-ECMO blood pH ≤ 7.11 (OR 1.7, 95 % CI 1.4-2.1), pre-ECMO bicarbonate use (OR 1.3, 95 % CI 1.2-1.5), prior ECMO exposure (OR 2.4, 95 % CI 1.6-2.6), and use of veno-arterial ECMO (OR 1.7, 95 % CI 1.4-2.0) increased neurologic complications. Mortality was higher in patients with neurologic complications compared to those without (62 % vs. 36 %; p < 0.001).
  
  
  CONCLUSIONS
  Neurologic complications are common in neonatal ECMO and are associated with increased mortality. Patient factors, pre-ECMO severity of illness, and use of veno-arterial ECMO are associated with increased neurologic complications. Patient selection, early ECMO deployment, and refining ECMO management strategies for vulnerable populations could be targeted as areas for improvement in neonatal ECMO.
authors.affiliation: Department of Cardiology and Cardiac Surgery, Cardiac Intensive Care Unit, Bambino Gesù Pediatric Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy. angelo.polito@opbg.net
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: Cindy S
authors.initials: CS
authors.lastname: Barrett
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Roberta
authors.initials: R
authors.lastname: Netto
authors.forename: Paola E
authors.initials: PE
authors.lastname: Cogo
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology*; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies