title: Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions.
  
  
  METHODS
  This was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support.
  
  
  METHODS
  The assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography.
  
  
  RESULTS
  Thirty-four infants <3 months of age were included in the study over a period of 18 months. The ECMO duration was 10±7 days. The survival rate was 50% (17/34 patients), and the proportion of brain injuries was 20% (7/34 patients). The mean StcO2 during ECMO in the non-survivors was reduced in both hemispheres (p = 0.0008 right, p = 0.03 left) compared to the survivors. StcO2 was also reduced in deceased or brain-injured patients compared to the survivors without brain injury (p = 0.002).
  
  
  CONCLUSIONS
  StcO2 appears to be a strong prognostic factor of survival and of the presence of cerebral lesions in young infants during ECMO.
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Marie-Philippine
authors.initials: MP
authors.lastname: Clair
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rambaud
authors.affiliation: Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis and Cardiovascular Functions, Center for Interdisciplinary Research in Biology (CIRB), INSERM, U1050, Paris, France.|CNRS, UMR 7241, Paris, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Flahault
authors.affiliation: Department of Emergency medicine, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guedj
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Guilbert
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Guellec
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Durandy
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Maryne
authors.initials: M
authors.lastname: Demoulin
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jean
authors.affiliation: Department of Neonatology, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Mitanchez
authors.affiliation: Department of Pediatric Radiology, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Chalard
authors.affiliation: Department of Pediatric Radiology, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Chiara
authors.initials: C
authors.lastname: Sileo
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.|Department of Emergency medicine, Trousseau Hospital, AP-HP, Paris, France.|UPMC Pierre et Marie Curie University, Paris VI, France.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
authors.affiliation: Department of Pediatric intensive care unit, Necker Hospital, AP-HP, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Renolleau
authors.affiliation: Department of Neonatal and Pediatric intensive care unit, Trousseau Hospital, AP-HP, Paris, France.
authors.forename: Pierre-Louis
authors.identifier: http://orcid.org/0000-0001-5234-9106
authors.initials: PL
authors.lastname: Léger
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D010100:Oxygen / Q000032:analysis* / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D015996:Survival Rate; D014463:Ultrasonography
chemical_list: D010100:Oxygen