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Abstract

Introduction:

The use of therapeutic hypothermia during neonatal extracorporeal membrane oxygenation (ECMO) as a neurologic protective strategy has gained interest among clinicians despite limited data. Our objective is to describe the relationship between the use of therapeutic hypothermia during neonatal ECMO and complications, mortality and functional status among survivors.

Methods:

Secondary analysis of data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Data were collected prospectively from 267 neonates (<30 days) undergoing ECMO at eight clinical sites. Twenty neonates received therapeutic hypothermia.

Results:

Neonates receiving therapeutic hypothermia were more likely to have intracranial hemorrhage during the first seven days of ECMO than were non-hypothermic neonates (40.0% vs 15.8%, p=0.012). No differences were observed between groups for hospital mortality or functional status at hospital discharge among survivors. Variables independently associated with intracranial hemorrhage in the first seven days of ECMO included therapeutic hypothermia, gestational age at birth, age at initiation of ECMO, fibrinogen concentration and mode of ECMO.

Conclusion:

Therapeutic hypothermia during neonatal ECMO appears to be associated with intracranial hemorrhage.

Keywords

therapeutic hypothermia extracorporeal membrane oxygenation neonates intracranial hemorrhage

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References

UK Collaborative ECMO Trial Group. UK collaborative randomized trial of neonatal extracorporeal membrane oxygenation. Lancet 1996; 348: 75–82.

Mugford

Elbourne

Field

Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database of Syst Rev 2008; 16: CD001340.

McNally

Bennett

Elbourne

et al . United Kingdom collaborative randomized trial of neonatal extracorporeal membrane oxygenation: follow-up to age 7 years. Pediatrics 2006; 117: e845-e854.

Madderom

Reuser

Utens

et al . Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study. Intensive Care Med 2013; 39: 1584–1593.

von Bahr

Hultman

Eksborg

et al . Long-term survival and causes of late death in children treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med 2017; 18: 272–280.

Cashen

Reeder

Dalton

et al . Functional status of neonatal and pediatric patients after extracorporeal membrane oxygenation. Pediatr Crit Care Med 2017: 18: 561–570.

Shankaran

Laptook

Ehrenkranz

et al . Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353: 1574–1584.

Azzopardi

Strohm

Edwards

et al . Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361: 1349–1358.

Simbruner

Mittal

Rohlmann

et al . Systemic hypothermia after neonatal encephalopathy: outcomes of neo.nEURO.network RCT. Pediatrics 2010; 126: e771-e778.

10.

Jacobs

Morley

Inder

et al . Whole-body hypothermia for term and near-term newborns with hypoxic ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165: 692–700.

11.

Moler

Silverstein

Holubkov

et al . Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med 2015; 372: 1898–1908.

12.

Moler

Silverstein

Holubkov

et al . Therapeutic hypothermia after in-hospital cardiac arrest in children. N Engl J Med 2017; 376: 318–329.

13.

Horan

Ichiba

Firmin

et al . A pilot investigation of mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO). J Pediatr 2004; 144: 301–308.

14.

Ichiba

Killer

Firmin

et al . Pilot investigation of hypothermia in neonates receiving extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2003; 88: F128–133.

15.

Massaro

Rais-Bahrami

Chang

et al . Therapeutic hypothermia for neonatal encephalopathy and extracorporeal membrane oxygenation. J Pediatr 2010; 157: 499–501.

16.

Field

Juszczak

Linsell

et al . NEST Study Collaborative Group. Neonatal ECMO study of temperature (NEST); a randomized controlled trial. Pediatrics 2013; 132: e1247-e1256.

17.

Dalton

Reeder

Garcia-Filion

et al . Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation (ECMO). Am J Respir Crit Care Med 2017; 196: 762–771.

18.

Ortiz

Cilley

Bartlett

RH.

Extracorporeal membrane oxygenation in pediatric respiratory failure. Pediatr Clin North Am 1987; 34: 39–46.

19.

Gaies

Gurney

Yen

et al . Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.

20.

Gaies

Jeffries

Niebler

et al . Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med 2014; 15: 529–537.

21.

Pollack

Holubkov

Glass

et al . Functional Status Scale: new pediatric outcome measure. Pediatrics 2009; 124: e18–e28.

22.

Lou

MacLaren

Paul

et al . Safety of therapeutic hypothermia in children on veno-arterial extracorporeal membrane oxygenation after cardiac surgery. Cardiol Young 2015; 25: 1367–1373.

23.

Short

BL.

The effect of extracorporeal life support on the brain: a focus on EMCO. Semin Perinatol 2005; 29: 45–50.

24.

De Mol

Liem

van Heijst

AFJ.

Cerebral aspects of neonatal extracorporeal membrane oxygenation: a review. Neonatology 2013; 104: 95–103.

25.

Doymaz

Zinger

Sweberg

Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO. J Intensive Care 2015; 3: 6.

26.

ELSO. Registry of the extracorporeal life support organization. Ann Arbor, MI: ELSO; www.elsonet.org. (2017, accessed 4 April 2017).

27.

Polderman

Herold

Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods. Crit Care Med 2009; 37: 1101–1120.

28.

Jacobs

Hunt

Tarnow-Mordi

et al . Cooling for newborns with hypoxic ischemic encephalopathy. Cochrane Database Syst Rev 2007: CD00331129.

29.

Massaro

Bouyssi-Kobar

Chang

et al . Brain perfusion in encephalopathic newborns after therapeutic hypothermia. AJNR Am J Neuroradiol. 2013; 34: 1649–1655.

30.

Wintermark

Hansen

Gregas

et al . Brain perfusion in asphyxiated newborns treated with therapeutic hypothermia. AJNR Am J Neuroradiol. 2011; 32: 2023–2029.

31.

Al Yazidi

Boudes

Tan

et al . Intraventricular hemorrhage in asphyxiated newborns treated with hypothermia: a look into incidence, timing and risk factors. BMC Pediatrics 2015; 15: 106.

32.

Plotz

van Oeveren

Bartlett

et al . Blood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg 1993; 105: 823–832.

33.

Robinson

Kickler

Walker

et al . Effect of extracorporeal membrane oxygenation on platelets in newborns. Crit Care Med 1993; 21: 1029–1034.

34.

Hardart

Fackler

JC.

Predictors of intracranial hemorrhage during neonatal extracorporeal membrane oxygenation. J Perinatol 1999; 134: 156–159.

35.

Hardart

Arnold

JH.

Intracranial hemorrhage in premature neonates treated with extracorporeal membrane oxygenation correlates with conceptional age. J Pediatr 2004; 145: 184–189.

36.

Smith

McMullan

Bratton

et al . Is age at initiation of extracorporeal life support associated with mortality and intraventricular hemorrhage in neonates with respiratory failure? J Perinatol 2014; 34: 386–391.

37.

Varnholt

Lasch

Sartoris

et al . Prognosis and outcome of neonates treated either with venoarterial (va) or veno-venous (vv) ECMO. Int J Artif Organs 1995; 18: 569–573.

38.

Anton-Martin

Journeycake

Modem

et al . Coagulation profile is not a predictor of acute cerebrovascular events in pediatric extracorporeal membrane oxygenation patients. ASAIO J 2017 63: 793–801.

39.

Dela Cruz

Stewart

Winston

et al . Risk factors for intracranial hemorrhage in the extracorporeal membrane oxygenation patient. J Perinatol 1997; 17: 18–23.

40.

Hirthler

Blackwell

Abbe

et al . Coagulation parameter instability as an early predictor of intracranial hemorrhage during extracorporeal membrane oxygenation. J Pediatr Surg 1992; 27: 40–43.

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Is therapeutic hypothermia during neonatal extracorporeal membrane oxygenation associated with intracranial hemorrhage?

Abstract

Introduction:

Methods:

Results:

Conclusion:

Keywords

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References

Supplementary Material