CT of cerebrovascular injury after neonatal extracorporeal membrane oxygenation: implications for neurodevelopmental outcome

Abstract

One hundred forty-six neonates treated with extracorporeal membrane oxygenation (ECMO) were evaluated with cranial sonography and CT at different times in the course of their disease. Cranial sonography was performed during treatment with ECMO, and CT was done 3-14 days after cessation of ECMO bypass. In 66 (45%), intracranial abnormalities were detected with either sonography or CT. Thirty neonates had hemorrhages only, 24 had nonhemorrhagic abnormalities, and 12 had combined lesions. CT provided additional information in 44 (67%) of the 66 neonates. Sonography was normal in 37 neonates, showed fewer lesions in 10 neonates, and was concordant with CT findings in 14 neonates. It cannot be established whether these lesions went undetected with sonography during ECMO, or occurred after cessation of ECMO bypass. Neurodevelopmental evaluation was performed in 71 of 90 survivors 1 year of age or older. Forty-three infants (61%) were normal; developmental delay was suspected in 12 (17%) and present in 16 (23%). The severity of intracranial abnormality as determined by a neuroimaging score correlated well with short-term developmental outcome. Mean neuroimaging scores were significantly higher, with increasing degree of neurodevelopmental delay (p less than .001 by Kruskal-Wallis rank order test). Although cranial sonography remains the primary technique for the detection of life-threatening hemorrhage during ECMO, cranial CT after ECMO is important in defining the total degree of intracranial injury present in these high-risk neonates.