title: Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation.
abstract: Neonates treated with extracorporeal membrane oxygenation are at risk for brain injury and subsequent neurodevelopmental compromise. Advances in MR imaging and improved accessibility have led to the increased use of routine MR imaging after extracorporeal membrane oxygenation. Our objective was to describe the frequency and patterns of extracorporeal membrane oxygenation-related brain injury based on MR imaging findings in a large contemporary cohort of neonates treated with extracorporeal membrane oxygenation.
  
  
  
  This was a retrospective study of neonatal patients treated with extracorporeal membrane oxygenation from 2005-2015 who underwent MR imaging before discharge. MR imaging and ultrasound studies were reviewed for location and type of parenchymal injury, ventricular abnormalities, and increased subarachnoid spaces. Parenchymal injury frequencies between patients treated with venoarterial and venovenous extracorporeal membrane oxygenation were compared by χ2tests.
  
  
  
  Of 81 neonates studied, 46% demonstrated parenchymal injury; 6% showed infarction, mostly in vascular territories (5% anterior cerebral artery, 5% MCA, 1% posterior cerebral artery); and 20% had hemorrhagic lesions. The highest frequency of injury occurred in the frontal (right, 24%; left, 25%) and temporoparietal (right, 14%; left, 19%) white matter. Sonography had low sensitivity for these lesions. Other MR imaging findings included volume loss (35%), increased subarachnoid spaces (44%), and ventriculomegaly (17% mild, 5% moderate, 1% severe). There were more parenchymal injuries in neonates treated with venoarterial (49%) versus venovenous extracorporeal membrane oxygenation (29%,P= .13), but the pattern of injury was consistent between both modes.
  
  
  
  MR imaging identifies brain injury in nearly half of neonates after treatment with extracorporeal membrane oxygenation. The frontal and temporoparietal white matter are most commonly affected, without statistically significant laterality. This pattern of injury is similar between venovenous and venoarterial extracorporeal membrane oxygenation, though the frequency of injury may be higher after venoarterial extracorporeal membrane oxygenation.
authors.affiliation: From the Divisions of Diagnostic Imaging and Radiology (M.A.W., M.T.W., D.B.).
authors.forename: M A
authors.identifier: 0000-0002-0634-4635
authors.initials: MA
authors.lastname: Wien
authors.affiliation: From the Divisions of Diagnostic Imaging and Radiology (M.A.W., M.T.W., D.B.).|The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.
authors.forename: M T
authors.identifier: 0000-0001-5077-693X
authors.initials: MT
authors.lastname: Whitehead
authors.affiliation: From the Divisions of Diagnostic Imaging and Radiology (M.A.W., M.T.W., D.B.).|Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.).|The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.
authors.forename: D
authors.identifier: 0000-0001-5003-2105
authors.initials: D
authors.lastname: Bulas
authors.affiliation: Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.).
authors.forename: M
authors.identifier: 0000-0002-7163-4751
authors.initials: M
authors.lastname: Ridore
authors.affiliation: Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.).|The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.
authors.forename: L
authors.identifier: 0000-0002-7420-0377
authors.initials: L
authors.lastname: Melbourne
authors.affiliation: the ECMO Program (G.O.), Children's National Health System, Washington, DC.
authors.forename: G
authors.identifier: 0000-0003-1041-9625
authors.initials: G
authors.lastname: Oldenburg
authors.affiliation: Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.).
authors.forename: B L
authors.identifier: 0000-0002-6785-9069
authors.initials: BL
authors.lastname: Short
authors.affiliation: Neonatology (D.B., M.R., L.M., B.L.S., A.N.M.) anguyenm@childrensnational.org.|The George Washington University School of Medicine (M.T.W., D.B., L.M., A.N.M.), Washington, DC.
authors.forename: A N
authors.identifier: 0000-0002-5543-6165
authors.initials: AN
authors.lastname: Massaro
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012189:Retrospective Studies; D013113:Spin Labels; D013346:Subarachnoid Space / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D013113:Spin Labels