MRI, MRA, AND NEURODEVELOPMENTAL OUTCOME FOLLOWING NEONATAL ECMO

Cranial magnetic resonance imaging (MRI) of 31 newborn infants treated with venoarterial cardiopulmonary bypass for severe but reversible re spiratory failure, revealed major focal parenchymal lesions in 7 of 31 infants (23%) and demonstrated abnormal enlargement of extra-axial an d ventricular cerebrospinal fluid spaces in 16 of 31 (51%). No prefere ntial left versus right lateralization of focal injury was observed in conjunction with right common carotid artery and jugular vein ligatio n. No statistically significant relationships were found between major brain lesions on MRI scans and the clinical characteristics of the pr e-extracorporeal membrane oxygenation (ECMO), ECMO, and post-ECMO cour se. Major focal brain lesions were significantly associated with an as ymmetric cerebrovascular response to carotid ligation of the right ver sus left middle cerebral arteries as detected by magnetic resonance an giography (P < .05). Enlarged cerebrospinal fluid spaces were not sign ificantly related to the presence of parenchymal MRI lesions, but were associated with lower Bayley neurodevelopmental scores for mental (MD I) and psychomotor evaluations (PDI) at 6 and 12 months (P < .05). It is concluded that asymmetries of cerebral vascular adaptation detected by magnetic resonance angiography after ECMO may be associated with m ajor brain lesions revealed by MRI. Thereafter, the presence of enlarg ed cerebrospinal fluid spaces on MRI is associated with a poor shortte rm developmental outcome.