Neonatal ECMO study of temperature (NEST): a randomized controlled trial

Area of Science:

• Neonatal medicine
• Pediatric neurology
• Critical care medicine

Background:

• High rates of impairment persist in newborn survivors treated with extracorporeal membrane oxygenation (ECMO).
• Therapeutic hypothermia is a neuroprotective strategy for asphyxiated mature infants.
• The study investigated if hypothermia during ECMO could reduce brain injury and subsequent impairment.

Purpose of the Study:

• To determine if mild therapeutic hypothermia during ECMO improves neurodevelopmental outcomes in newborn infants.
• To assess the impact of hypothermia on cognitive scores and other neurodevelopmental and behavioral outcomes at two years of age.

Main Methods:

• A randomized trial comparing ECMO with cooling (34°C) versus standard ECMO (37°C) in the UK.
• Primary outcome: cognitive composite score using Bayley Scales of Infant and Toddler Development, 3rd edition, at 2 years.
• Secondary outcomes included mortality, neonatal morbidity, and neurodevelopmental/behavioral assessments.

Main Results:

• 111 infants were enrolled; 14 died before 2 years (16% ECMO with cooling vs. 9% ECMO alone).
• No significant difference in mean cognitive scores at 2 years between groups (88.0 with cooling vs. 90.6 without).
• Secondary outcomes also showed no significant differences, with most favoring ECMO without cooling.

Conclusions:

• Mild hypothermia for 48-72 hours during ECMO did not improve outcomes in newborn infants up to 2 years.
• The findings suggest that this hypothermia protocol does not enhance neurodevelopmental recovery in this population.