Article

AIM: To examine the neurobiology of long-term neuropsychological deficits after
neonatal extracorporeal membrane oxygenation (ECMO). METHOD: This cross-sectional
study assessed white matter integrity and hippocampal volume of ECMO survivors
(8-15y) and healthy children
(8-17y) using diffusion tensor imaging (DTI) and
structural magnetic resonance imaging (MRI) respectively. Neuropsychological
outcome was evaluated in ECMO survivors. Included clinical predictors of white
matter integrity: age start ECMO, ECMO duration, highest oxygenation index before
ECMO, highest mean airway pressure, and mechanical ventilation duration. RESULTS:
ECMO survivors (n=23) had lower global fractional anisotropy than healthy
children (n=54) (patients=0.368; comparison group=0.381; p=0.018), but similar
global mean diffusivity (p=0.410). ECMO survivors had lower fractional anisotropy
in the left cingulum bundle (ECMO survivors=0.345; comparison group=0.399;
p<0.001) and higher mean diffusivity in a region of the left parahippocampal
cingulum (patients=0.916; comparison group=0.871; p<0.001). Higher global mean
diffusivity predicted worse verbal memory in ECMO survivors (n=17) (beta=-0.74,
p=0.008). ECMO survivors (n=23) had smaller bilateral hippocampal volume than
healthy children (n=43) (left, p<0.001; right, p<0.001) and this was related to
worse verbal memory (left, beta=0.65, p=0.018; right, beta=0.71, p=0.006).
INTERPRETATION: Neonatal ECMO survivors are at risk for long-term brain
alterations, which may partly explain long-term neuropsychological impairments.
Neuroimaging may contribute to better risk stratification of long-term impairments.
CI - (c) 2016 Mac Keith Press.

Langue : ANGLAIS