SEVERITY OF BRAIN INJURY FOLLOWING NEONATAL EXTRACORPOREAL MEMBRANE-OXYGENATION AND OUTCOME AT AGE-5 YEARS

Neurodevelopmental evaluation in childhood provides an opportunity to study complex neurological compensation following documented neonatal brain injury, and furnishes important clinical information which may h ave an impact on patient care. We studied 152 term children treated wi th extracorporeal membrane oxygenation (ECMO) as neonates and who rece ived routine neonatal neuroimaging and comprehensive neurodevelopmenta l evaluation at age 5 years. The cohort was divided into four groups b ased on an independent neuroimaging score: No lesion, N = 88; Mild les ion, N = 38; Moderate lesion, N = 12; and Severe lesion, N = 14. Stand ardized testing at age 5 included complete neuropsychological assessme nt, neurological evaluation, and assessment of motor function. All tes ting was conducted without knowledge of the neuroimaging score. The oc currence of disability by severity of neuroimaging was: No lesion = 10 %; Mild = 13%; Moderate = 33%; Severe = 57%, The relative risk within the ECMO population for disability at age 5 after moderate or severe n eonatal lesion was 4.3 (CI = 1.0 to 17.5) and 11.7 (CI = 3.3 to 41.3), respectively. The remaining non-disabled children who had moderate to severe lesions functioned within normal limits. Severity of neonatal neuroimaging was inversely associated with IQ scores, pre-academic ski lls, and neuromotor function. The effect size was small but the rank o rder was predictable. Our data identify in 5-year-old children an impa ct of brain lesion severity demonstrated on routine neonatal neuroimag ing. The results indicate potential compensation following moderate an d severe lesions, and suggest a subtle but consistent influence of eve n mild neonatal brain injury.