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Adrenal hemorrhage in infants undergoing ECMO: prevalence and clinical significance
C M Sivit1, B L Short, M E Revenis
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC 20010.
Insights
Adrenal hemorrhage is uncommon in infants receiving extracorporeal membrane oxygenation (ECMO) therapy. In this study, diagnosed adrenal hemorrhages did not lead to clinical complications in infants on ECMO.
Area of Science:
- Pediatric Critical Care
- Neonatology
- Medical Imaging
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for neonates with severe cardiorespiratory failure.
- Adrenal complications, including hemorrhage, can occur in critically ill infants.
- Understanding the incidence and impact of adrenal hemorrhage during ECMO is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of adrenal hemorrhage in infants undergoing ECMO.
- To assess the clinical significance and potential complications of adrenal hemorrhage in this population.
Main Methods:
- Prospective ultrasonography (US) of the adrenal glands in 50 consecutive infants on ECMO.
- Regular US examinations (at least every other day) during ECMO support.
- Diagnosis of adrenal hemorrhage based on US findings of suprarenal mass or adrenal gland enlargement.
Main Results:
- Adrenal hemorrhage was identified in 4% of infants (2 out of 50).
- Hemorrhages were unilateral and occurred within the first three days of ECMO.
- No association was found between adrenal hemorrhage and acute hematocrit drop or adrenal insufficiency.
Conclusions:
- Adrenal hemorrhage is an infrequent complication in infants undergoing ECMO.
- In this series, identified adrenal hemorrhages did not result in discernible clinical complications.
- Further research may be warranted to fully elucidate long-term outcomes.
Objective:
To determine the prevalence and clinical significance of adrenal hemorrhage in infants undergoing ECMO therapy.
Methods:
Prospective US evaluation of the adrenal glands was performed in 50 consecutive infants undergoing ECMO. The infants were examined at least every other day while on bypass. Adrenal hemorrhage was diagnosed at US examination when a suprarenal mass or adrenal gland enlargement was identified.
Results:
Adrenal hemorrhage was identified in two infants (4%); one infant with septicemia, and one with primary pulmonary hypertension. Both hemorrhages were unilateral; one was right-sided, and one left-sided. One hemorrhage occurred on the first day following the onset of ECMO and the other on the third day. The adrenal hemorrhage was not associated with an acute drop in hematocrit nor with adrenal insufficiency in either infant.
Conclusion:
Adrenal hemorrhage is uncommon in infants undergoing ECMO. When hemorrhage did occur in this series, it did not result in clinical complications.