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Predictors of intracranial hemorrhage in neonatal patients on extracorporeal membrane oxygenation
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- Wood, Sara (author)
- Karolinska Univ Hosp, ECMO Ctr Karolinska, Intens Care & Transport, Pediat Perioperat Med & Intens Care, Akad Straket 14, S-17176 Stockholm, Sweden.
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- Iacobelli, Riccardo (author)
- Karolinska Univ Hosp, ECMO Ctr Karolinska, Intens Care & Transport, Pediat Perioperat Med & Intens Care, Akad Straket 14, S-17176 Stockholm, Sweden.
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- Kopfer, Sarah (author)
- Karolinska Univ Hosp, ECMO Ctr Karolinska, Intens Care & Transport, Pediat Perioperat Med & Intens Care, Akad Straket 14, S-17176 Stockholm, Sweden.
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- Karolinska Univ Hosp, ECMO Ctr Karolinska, Intens Care & Transport, Pediat Perioperat Med & Intens Care, Akad Straket 14, S-17176 Stockholm, Sweden Förvärvade hjärnskador (creator_code:org_t)
- Springer Nature, 2023
- 2023
- English.
- In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13:1
- Journal article (peer-reviewed)
Abstract
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- Extracorporeal membrane oxygenation (ECMO) is a life-supportive treatment in neonatal patients with refractory lung and/or heart failure. Intracranial hemorrhage (ICH) is a severe complication and reliable predictors are warranted. The aims of this study were to explore the incidence and possible predictors of ICH in ECMO-treated neonatal patients. We performed a single-center retrospective observational cohort study. Patients aged <= 28 days treated with ECMO between 2010 and 2018 were included. Exclusion criteria were ICH, ischemic stroke, cerebrovascular malformation before ECMO initiation or detected within 12 h of admission, ECMO treatment < 12 h, or prior treatment with ECMO at another facility > 12 h. The primary outcome was a CT-verified ICH. Logistic regression models were employed to identify possible predictors of the primary outcome. Of the 223 patients included, 29 (13%) developed an ICH during ECMO treatment. Thirty-day mortality was 59% in the ICH group and 16% in the non-ICH group (p < 0.0001). Lower gestational age (p < 0.01, odds ratio (OR) 0.96; 95%CI 0.94-0.98), and higher pre-ECMO lactate levels (p = 0.017, OR 1.1; 95%CI 1.01-1.18) were independently associated with increased risk of ICH-development. In the clinical setting, identification of risk factors and multimodal neuromonitoring could help initiate steps that lower the risk of ICH in these patients.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
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