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Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Brain development in newborns and infants after ECMO
Kai Yan1, Lu-Kun Tang1,2,3, Fei-Fan Xiao1
1Department of Neonatology, Children Hospital of Fudan University, Shanghai, 201102, China.
Insights
Extracorporeal membrane oxygenation (ECMO) can lead to neurodevelopmental issues in neonates. Early detection and intervention are crucial for improving long-term outcomes in ECMO survivors.
Area of Science:
- Neonatal care
- Neuroscience
- Pediatric intensive care
Background:
- Extracorporeal membrane oxygenation (ECMO) improves survival in critically ill neonates.
- ECMO is also linked to long-term neurodevelopmental challenges in infants.
- Understanding these outcomes is vital for optimizing infant care.
Purpose of the Study:
- To systematically review neurodevelopmental outcomes in neonates and infants post-ECMO.
- To identify incidence, prevalence, and risk factors for motor, cognitive, and sensory deficits.
- To explore current nursing and management strategies for ECMO survivors.
Main Methods:
- Comprehensive literature search across PubMed, EMBASE, and Web of Science.
- Screening of titles/abstracts, followed by full-text assessment of relevant studies.
- Quality evaluation of studies and citation searches for comprehensive data retrieval.
Main Results:
- Approximately 50% of neonates post-ECMO show brain injury, with neurological complications.
- Seizures (18-23%) and bleeding events (27-60%) are common; ischemic strokes occur in up to 33%.
- ECMO may be associated with developmental delays, impacting cognitive, motor, and language functions, though sensory impacts remain unclear.
Conclusions:
- Further large-scale, long-term studies are needed to fully elucidate ECMO's impact on infant neurodevelopment.
- Optimized management, nursing care, patient selection, and early rehabilitation are key to improving outcomes.
- Early detection and multidisciplinary follow-up are essential for ECMO survivors.
Background:
Extracorporeal membrane oxygenation (ECMO) not only significantly improves survival rates in severely ill neonates but also is associated with long-term neurodevelopmental issues. To systematically review the available literature on the neurodevelopmental outcomes of neonates and infants who have undergone ECMO treatment, with a focus on motor deficits, cognitive impairments, sensory impairments, and developmental delays. This review aims to understand the incidence, prevalence, and risk factors for these problems and to explore current nursing care and management strategies.
Data Sources:
A comprehensive literature search was performed across PubMed, EMBASE, and Web of Science using a wide array of keywords and phrases pertaining to ECMO, neonates, infants, and various facets of neurodevelopment. The initial screening involved reviewing titles and abstracts to exclude irrelevant articles, followed by a full-text assessment of potentially relevant literature. The quality of each study was evaluated based on its research methodology and statistical analysis. Moreover, citation searches were conducted to identify potentially overlooked studies. Although the focus was primarily on neonatal ECMO, studies involving children and adults were also included due to the limited availability of neonate-specific literature.
Results:
About 50% of neonates post-ECMO treatment exhibit varying degrees of brain injury, particularly in the frontal and temporoparietal white matter regions, often accompanied by neurological complications. Seizures occur in 18%-23% of neonates within the first 24 hours, and bleeding events occur in 27%-60% of ECMO procedures, with up to 33% potentially experiencing ischemic strokes. Although some studies suggest that ECMO may negatively impact hearing and visual development, other studies have found no significant differences; hence, the influence of ECMO remains unclear. In terms of cognitive, language, and intellectual development, ECMO treatment may be associated with potential developmental delays, including lower composite scores in cognitive and motor functions, as well as potential language and learning difficulties. These studies emphasize the importance of early detection and intervention of potential developmental issues in ECMO survivors, possibly necessitating the implementation of a multidisciplinary follow-up plan that includes regular neuromotor and psychological evaluations. Overall, further multicenter, large-sample, long-term follow-up studies are needed to determine the impact of ECMO on these developmental aspects.
Conclusions:
The impact of ECMO on an infant's nervous system still requires further investigation with larger sample sizes for validation. Fine-tuned management, comprehensive nursing care, appropriate patient selection, proactive monitoring, nutritional support, and early rehabilitation may potentially contribute to improving the long-term outcomes for these infants.
