Bleeding Complications in Neonates Receiving Extracorporeal Membrane Oxygenation and Controlled Hypothermia

Abstract

Objective Safety and efficacy data on controlled hypothermia (CH) for neonates with moderate to severe hypoxic ischemic encephalopathy has been extrapolated to a subgroup of these patients who also require extracorporeal membrane oxygenation for refractory persistent pulmonary hypertension of the newborn (PPHN). However, safety data on the concomitant use of CH and extracorporeal membrane oxygenation (ECMO) are lacking.

Methods This is a single-center retrospective study of neonates ≥35 weeks' gestation with refractory PPHN who required ECMO between January 2010 and December 2020. Study groups were divided into those receiving CH/ECMO versus ECMO only. Baseline characteristics, short-term outcomes, and brain magnetic resonance imaging (MRI) data were compared.

Results A total of 36 neonates who received ECMO for refractory PPHN were included. Of these, 44.4% (n = 16) received CH/ECMO and 55.6% (n = 20) received ECMO only. Bleeding complications were more common in CH/ECMO group 50% (n = 8) versus ECMO only 15% (n = 3, p = 0.023). T1 brain MRI severity scores were higher in CH/ECMO group versus ECMO only group, however, there were no statistical difference in T2 and diffusion-weighted image scores. Functional status and survival to discharge were comparable between groups.

Conclusion In our cohort, neonates who received CH/ECMO had higher bleeding complications than ECMO only group with comparable functional status and survival at discharge.

Key Points

• Safety data on the concomitant use of CH and ECMO are lacking in neonates.

• In our cohort, neonates who received CH/ECMO had higher bleeding complications than ECMO only group.

• Functional status and survival to discharge were no differences between the two groups.

Keywords

controlled hypothermia - extracorporeal membrane oxygenation - Extracorporeal Life Support Organization - hypoxic ischemic encephalopathy - persistent pulmonary hypertension of the newborn - summary score

Note

IRB#4 Saint Christopher's Hospital for Children/The Drexel University Institutional Review Board approved the study ID: 1810006712, with a HIPAA Waiver of Authorization

Authors' Contributions

S.J. conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. E.P. reviewed MRIs and scored the patients and reviewed the manuscript. V.Q.C. and O.M. conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publikationsverlauf

Eingereicht: 09. September 2021

Angenommen: 28. Februar 2022

Accepted Manuscript online:
03. März 2022

Artikel online veröffentlicht:
17. Mai 2022

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