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White Matter Integrity Differences in 2-Year-Old Children Treated With ECMO: A Diffusion-Weighted Imaging Study.

Michaela Ruttorf^1,2, Julia Filip^1,2, Thomas Schaible³

¹Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

The European Journal of Neuroscience

|February 18, 2025

Summary

Diffusion-weighted imaging (DWI) detects white matter alterations in 2-year-old survivors of neonatal extracorporeal membrane oxygenation (ECMO) treatment. These early brain changes correlate with later neurodevelopmental delays, offering a non-invasive assessment tool.

Keywords:

congenital diaphragmatic hernia neurodevelopmental delays neuroimaging tract‐based spatial statistics

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Area of Science:

Neuroimaging
Developmental Neuroscience
Neonatal Medicine

Background:

Neonatal extracorporeal membrane oxygenation (ECMO) survivors often experience long-term neurodevelopmental deficits.
Neuropsychological testing in follow-up programs documents these delays, including memory, spatial, and motor issues.
Early detection of brain alterations could improve long-term outcomes for these children.

Purpose of the Study:

To investigate if diffusion-weighted imaging (DWI) can identify white matter (WM) changes in infants treated with neonatal ECMO.
To correlate early DWI findings with known neurodevelopmental outcomes observed later in life.
To establish DWI as an objective tool for assessing structural brain changes in ECMO survivors.

Main Methods:

Utilized diffusion-weighted imaging (DWI) on 56 children, comparing ECMO survivors with a control group.
Calculated diffusion metrics: fractional anisotropy (FA), first fibre partial volume fraction (F1), radial diffusivity (RD), and mean diffusivity (MD).
Employed tract-based spatial statistics with a pediatric brain atlas to analyze WM tracts and specific brain regions.

Main Results:

Significant differences in FA, F1, RD, and MD were observed in major WM tracts between ECMO and no-ECMO groups.
Specific regions, including the corpus callosum, internal capsule, and fornix, showed significant diffusion measure variations.
These identified WM alterations in ECMO survivors align with reported neurodevelopmental delays.

Conclusions:

DWI at two years of age effectively detects structural white matter changes in neonatal ECMO survivors.
Early DWI analysis serves as a valuable, non-participatory tool for identifying potential neurodevelopmental risks.
Findings suggest DWI can complement or precede traditional neuropsychological assessments in ECMO follow-up programs.