INTRACRANIAL ABNORMALITIES IN INFANTS TREATED WITH EXTRACORPOREAL MEMBRANE-OXYGENATION - UPDATE ON SONOGRAPHIC AND CT FINDINGS

PURPOSE: To determine the frequency of intracranial lesions in infants treated with extracorporeal membrane oxygenation (ECMO), to evaluate trends in frequency during an 8-year period, and to determine which in fants are at highest risk for intracranial injury. METHODS: Daily sono grams were obtained in 386 infants during treatment with ECMO, Cranial CT scans were acquired after decannulation in 286 of 322 survivors, A bnormalities were classified as major or minor and hemorrhagic or nonh emorrhagic. Results were correlated with infant demographic data. RESU LTS: Intracranial abnormalities were detected in 203 (52%) of the 386 infants; 73 (19%) hemorrhagic, 86 (22%) nonhemorrhagic, and 44 (11%) c ombined lesions. Eighty-two lesions (21%) were classified as major, Fo rty-six (94%) of 49 major hemorrhages were identified at sonography. C T contributed additional information in 73% of neonates with intracran ial abnormalities, of which 17 were major lesions not identified at so nography. The frequency of intracranial hemorrhage was increased in in fants who were septic or premature or weighed less than 2.5 kg. An inc rease in time spent on ECMO bypass increased the risk for nonhemorrhag ic injury. During an 8-year period, the frequency of hemorrhagic and m ajor nonhemorrhagic lesions remained constant, whereas minor nonhemorr hagic abnormalities increased significantly. CONCLUSION: Infants treat ed with ECMO continue to be at high risk for cerebrovascular injury. A lthough daily sonograms are useful in identifying major hemorrhages, f ollow-up CT scans are crucial for accurate evaluation of intracranial abnormalities.