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Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: update on sonographic and CT
D I Bulas1, G A Taylor, R M O'Donnell
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA.
Insights
Infants on extracorporeal membrane oxygenation (ECMO) face high risks of brain injury. Daily ultrasounds detect major bleeds, but CT scans are vital for a complete assessment of intracranial abnormalities.
Area of Science:
- Neonatal Neurology
- Pediatric Critical Care
- Neuroimaging
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill neonates.
- Cerebrovascular injury is a significant concern in infants undergoing ECMO.
- Understanding the patterns and risk factors for intracranial lesions is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence of intracranial lesions in infants treated with ECMO.
- To analyze trends in lesion frequency over an 8-year period.
- To identify infants at highest risk for ECMO-related intracranial injury.
Main Methods:
- Daily cranial sonography was performed on 386 infants during ECMO.
- Cranial CT scans were obtained post-decannulation in 286 survivors.
- Lesions were classified as major/minor and hemorrhagic/nonhemorrhagic, correlated with infant data.
Main Results:
- 52% of infants had intracranial abnormalities; 19% hemorrhagic, 22% nonhemorrhagic, 11% combined.
- Major lesions occurred in 21%; 94% of major hemorrhages detected by sonography.
- CT identified additional major lesions in 73% of neonates with abnormalities. Sepsis, prematurity, low birth weight, and longer ECMO duration increased risk.
Conclusions:
- Infants on ECMO remain at high risk for cerebrovascular injury.
- Daily sonography is effective for detecting major hemorrhages.
- Follow-up CT scans are essential for comprehensive evaluation of intracranial abnormalities.
Purpose:
To determine the frequency of intracranial lesions in infants treated with extracorporeal membrane oxygenation (ECMO), to evaluate trends in frequency during an 8-year period, and to determine which infants are at highest risk for intracranial injury.
Methods:
Daily sonograms were obtained in 386 infants during treatment with ECMO. Cranial CT scans were acquired after decannulation in 286 of 322 survivors. Abnormalities were classified as major or minor and hemorrhagic or nonhemorrhagic. Results were correlated with infant demographic data.
Results:
Intracranial abnormalities were detected in 203 (52%) of the 386 infants; 73 (19%) hemorrhagic, 86 (22%) nonhemorrhagic, and 44 (11%) combined lesions. Eighty-two lesions (21%) were classified as major. Forty-six (94%) of 49 major hemorrhages were identified at sonography. CT contributed additional information in 73% of neonates with intracranial abnormalities, of which 17 were major lesions not identified at sonography. The frequency of intracranial hemorrhage was increased in infants who were septic or premature or weighed less than 2.5 kg. An increase in time spent on ECMO bypass increased the risk for nonhemorrhagic injury. During an 8-year period, the frequency of hemorrhagic and major nonhemorrhagic lesions remained constant, whereas minor nonhemorrhagic abnormalities increased significantly.
Conclusion:
Infants treated with ECMO continue to be at high risk for cerebrovascular injury. Although daily sonograms are useful in identifying major hemorrhages, follow-up CT scans are crucial for accurate evaluation of intracranial abnormalities.