The utility of cranial ultrasound as a screening tool for neonatal ECMO
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Abstract
Background
Neurologic complications including hemorrhage, ischemia, and infarction are often identified in neonates undergoing extracorporeal membrane oxygenation (ECMO) and may contribute to the high morbidity observed in ECMO survivors. Screening for intracranial complications is reliant on bedside transcranial ultrasound (CUS) prior to and during ECMO therapy, and advanced imaging [i.e. computed tomography (CT)/magnetic resonance imaging (MRI)] is recommended after completion of ECMO support. The goal of this study is to describe the correlation of intracranial complications identified on CUS during ECMO and MRI after completion of ECMO.
Methods
Fifty-five neonates underwent ECMO support at the Children’s Hospital of Georgia at Augusta University from January 1, 2012 to December 31, 2017. Forty-four (80%) had a brain MRI performed prior to transfer or discharge. Ultrasound studies were reviewed by a single blinded pediatric radiologist and MRIs were reviewed by a single blinded neuro-radiologist.
Results
Of the 44 neonates with post-ECMO MRI, CUS during ECMO identified intracranial lesions in nine neonates, which were all confirmed on post-ECMO MRI. Sixteen subjects (46%) with unremarkable CUS during ECMO had identifiable lesions on post-ECMO MRI, yielding a sensitivity of 36% and a specificity of 100% for CUS in the detection of intracranial lesions. Despite the lack of correlation between CUS and MR, 84.6% of survivors exhibited normal development at 24 months of age.
Conclusion
While necessary for the identification of intracranial lesions during neonatal ECMO, CUS demonstrated low correlation with post-ECMO MRI in the identification of intracranial lesions, which supports Extracorporeal Life Support Organization (ELSO) recommendations.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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Articles in the same Issue
- Frontmatter
- Review
- Variations in long-term outcome reporting among offspring followed up after lifestyle interventions in pregnancy: a systematic review
- Corner of Academy
- Modifiable risk factors for spontaneous preterm birth in nulliparous women: a prospective study
- Additional benefits of three-dimensional ultrasound for prenatal assessment of twins
- Original Articles – Obstetrics
- Microbial burden and inflammasome activation in amniotic fluid of patients with preterm prelabor rupture of membranes
- Amniotic fluid concentrations of soluble endoglin and endothelial cell-specific molecule-1 in pregnancies complicated with neural tube defects
- Maternal characteristics and pregnancy outcomes of women with chronic hypertension: a population-based study
- Behavior of fetal longitudinal myocardial fibers assessed by speckle tracking to obtain strain and strain rate values for low-risk pregnancies
- The effect of a scheduled regimen of acetaminophen and ibuprofen on opioid use following cesarean delivery
- Original Articles – Fetus
- Comparison of cord blood lactate measurement by gas analyzer and portable electrochemical devices
- Perinatal mortality: epidemiological profile, causes and avoidable factors at a reference public maternity hospital in the State of Santa Catarina, Brazil, 2011–2015
- Original Articles – Newborns
- Maternal smoking and cannabis use during pregnancy and infant outcomes
- The utility of cranial ultrasound as a screening tool for neonatal ECMO
- Effects of human milk fortifier properties on intrinsic probiotic bacteria
- Letter to the Editor
- Superb microvascular imaging with Doppler luminance using an 18-MHz probe to visualize fetal intra-abdominal blood vessels and organ microvasculature
