The Impact of Venoarterial and Venovenous Extracorporeal Membrane Oxygenation on Cerebral Metabolism in the Newborn Brain

BackgroundExtracorporeal membrane oxygenation (ECMO) is an effective therapy for supporting infants with reversible cardiopulmonary failure. Still, survivors are at risk for long-term neurodevelopmental impairments, the cause of which is not fully understood.ObjectiveTo elucidate the effects of ECMO on the newborn brain. We hypothesized that the cerebral metabolic profile of neonates who received ECMO would differ from neonates who did not receive ECMO. To address this, we used magnetic resonance spectroscopy (1H-MRS) to investigate the effects of venoarterial and venovenous ECMO on cerebral metabolism.Methods41 neonates treated with ECMO were contrasted to 38 age-matched neonates.ResultsAll 1H-MRS data were acquired from standardized grey matter and white matter regions of interest using a short-echo (TE = 35 milliseconds), point-resolved spectroscopy sequence (PRESS) and quantitated using LCModel. Metabolite concentrations (mmol/kg) were compared across groups using multivariate analysis of covariance. Elevated creatine (p = 0.002) and choline (p = 0.005) concentrations were observed in the grey matter among neonates treated with ECMO relative to the reference group. Likewise, choline concentrations were elevated in the white matter (p = 0.003) while glutamate was reduced (p = 0.03). Contrasts between ECMO groups revealed lower osmolite concentrations (e.g. myoinositol) among the venovenous ECMO group.ConclusionNeonates who underwent ECMO were found to have an abnormal cerebral metabolic profile, with the pattern of abnormalities suggestive of an underlying inflammatory process. Additionally, neonates who underwent venovenous ECMO had low cerebral osmolite concentrations as seen in vasogenic edema.

背景：体外膜肺氧合（Extracorporeal membrane oxygenation, ECMO）是支持可逆性心肺衰竭患儿的有效治疗手段，但接受该治疗的存活患儿仍存在长期神经发育障碍的风险，其具体致病机制尚未完全阐明。研究目的：阐明ECMO对新生儿大脑的影响。本研究假设接受ECMO治疗的新生儿，其大脑代谢特征与未接受ECMO治疗的新生儿存在差异。为此，我们采用氢质子磁共振波谱（1H-MRS, magnetic resonance spectroscopy）技术，探究静脉-动脉及静脉-静脉ECMO对大脑代谢的影响。研究方法：本研究纳入41名接受ECMO治疗的新生儿，并以38名年龄匹配的新生儿作为对照。研究结果：所有氢质子磁共振波谱（1H-MRS）数据均采集自标准化选定的灰质与白质感兴趣区，采用短回波（TE=35毫秒）点解析波谱序列（PRESS, point-resolved spectroscopy sequence）进行采集，并通过LCModel软件完成定量分析。采用多变量协方差分析对各组间的代谢物浓度（单位：mmol/kg）进行比较。与对照组相比，接受ECMO治疗的新生儿灰质中肌酸（p=0.002）与胆碱（p=0.005）浓度均显著升高。同样，其白质中胆碱浓度升高（p=0.003），而谷氨酸浓度降低（p=0.03）。不同ECMO模式组间的对比显示，静脉-静脉ECMO组的渗透压物质（如肌醇）浓度更低。研究结论：本研究发现接受ECMO治疗的新生儿存在大脑代谢特征异常，其异常模式提示存在潜在的炎症过程。此外，接受静脉-静脉ECMO治疗的新生儿大脑渗透压物质浓度较低，该表现与血管源性水肿的特征相符。