title: The Impact of Venoarterial and Venovenous Extracorporeal Membrane Oxygenation on Cerebral Metabolism in the Newborn Brain.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is an effective therapy for supporting infants with reversible cardiopulmonary failure. Still, survivors are at risk for long-term neurodevelopmental impairments, the cause of which is not fully understood.
  
  
  OBJECTIVE
  To elucidate the effects of ECMO on the newborn brain. We hypothesized that the cerebral metabolic profile of neonates who received ECMO would differ from neonates who did not receive ECMO. To address this, we used magnetic resonance spectroscopy (1H-MRS) to investigate the effects of venoarterial and venovenous ECMO on cerebral metabolism.
  
  
  METHODS
  41 neonates treated with ECMO were contrasted to 38 age-matched neonates.
  
  
  RESULTS
  All 1H-MRS data were acquired from standardized grey matter and white matter regions of interest using a short-echo (TE = 35 milliseconds), point-resolved spectroscopy sequence (PRESS) and quantitated using LCModel. Metabolite concentrations (mmol/kg) were compared across groups using multivariate analysis of covariance. Elevated creatine (p = 0.002) and choline (p = 0.005) concentrations were observed in the grey matter among neonates treated with ECMO relative to the reference group. Likewise, choline concentrations were elevated in the white matter (p = 0.003) while glutamate was reduced (p = 0.03). Contrasts between ECMO groups revealed lower osmolite concentrations (e.g. myoinositol) among the venovenous ECMO group.
  
  
  CONCLUSIONS
  Neonates who underwent ECMO were found to have an abnormal cerebral metabolic profile, with the pattern of abnormalities suggestive of an underlying inflammatory process. Additionally, neonates who underwent venovenous ECMO had low cerebral osmolite concentrations as seen in vasogenic edema.
authors.affiliation: Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Department of Pediatrics, Division of Neonatal Medicine, University of Southern California, Los Angeles, California, United States of America.|Department of Pediatrics, Division of Neonatal Medicine, Los Angeles County University of Southern California Medical Center, Los Angeles, California, United States of America.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Reitman
authors.affiliation: Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Department of Pediatrics, Division of Neonatal Medicine, University of Southern California, Los Angeles, California, United States of America.
authors.forename: Rachel
authors.initials: R
authors.lastname: Chapman
authors.affiliation: Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Department of Surgery, University of Southern California, Los Angeles, California, United States of America.
authors.forename: James E
authors.initials: JE
authors.lastname: Stein
authors.affiliation: Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Department of Pediatrics, Division of Neonatal Medicine, University of Southern California, Los Angeles, California, United States of America.
authors.forename: Lisa
authors.initials: L
authors.lastname: Paquette
authors.affiliation: Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Ashok
authors.initials: A
authors.lastname: Panigrahy
authors.affiliation: Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America.
authors.forename: Marvin D
authors.initials: MD
authors.lastname: Nelson
authors.affiliation: Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Department of Pediatrics, Division of Neonatal Medicine, University of Southern California, Los Angeles, California, United States of America.
authors.forename: Philippe
authors.initials: P
authors.lastname: Friedlich
authors.affiliation: Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America.|Rudi Schulte Research Institute, Santa Barbara, California, United States of America.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Wisnowski
authors.affiliation: Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America.|Rudi Schulte Research Institute, Santa Barbara, California, United States of America.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bluml
mesh_terms: D001158:Arteries; D001921:Brain / Q000378:metabolism*; D016022:Case-Control Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014680:Veins