title: Brain injury associated with neonatal extracorporeal membrane oxygenation in the Netherlands: a nationwide evaluation spanning two decades.
abstract: OBJECTIVE
  To determine the prevalence of and to classify ultrasound-proven brain injury during neonatal extracorporeal membrane oxygenation in The Netherlands.
  
  
  METHODS
  Retrospective nationwide study (Rotterdam and Nijmegen), spanning two decades.
  
  
  METHODS
  Level III university hospitals.
  
  
  METHODS
  All neonates who underwent neonatal extracorporeal membrane oxygenation from 1989 to 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  Cranial ultrasound images were reviewed independently by two investigators without knowledge of primary diagnosis, outcome, type of extracorporeal membrane oxygenation, or statistics. The scans were reviewed for lesion type and timing, with the use of a refined classification method for focal brain injury. Extracorporeal membrane oxygenation type was venoarterial in 88%. Brain abnormalities were detected in 17.3%: primary hemorrhage was most frequent (8.8%). Stroke was identified in 5% of the total group, with a notable significant preference for the left hemisphere (in 70%). Lobar hematoma (prevalence 2.2 %) was also significantly left predominant.
  
  
  CONCLUSIONS
  The incidence of brain injury found with cranial ultrasound in The Netherlands of the patients treated with extracorporeal membrane oxygenation during the neonatal period was 17.3%. Primary hemorrhage was the largest group of lesions, not clearly side-specific except for lobar bleeding, most probably related to changes in venous flow. Arterial ischemic stroke occurred predominant in the left hemisphere.
authors.affiliation: 1Department of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 2Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 3Department of Neonatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 4Department of Pediatric Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 5Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium.
authors.forename: Marlou M A
authors.initials: MM
authors.lastname: Raets
authors.forename: Jeroen
authors.initials: J
authors.lastname: Dudink
authors.forename: Hanneke
authors.initials: H
authors.lastname: Ijsselstijn
authors.forename: Arno F J
authors.initials: AF
authors.lastname: van Heijst
authors.forename: Maarten H
authors.initials: MH
authors.lastname: Lequin
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Houmes
authors.forename: Enno D
authors.initials: ED
authors.lastname: Wildschut
authors.forename: Irwin K M
authors.initials: IK
authors.lastname: Reiss
authors.forename: Paul
authors.initials: P
authors.lastname: Govaert
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005865:Gestational Age; D006406:Hematoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D014463:Ultrasonography