Extracorporeal Membrane Oxygenation (ECMO) is a temporary procedure for treating human neonates who have reversible, severely impaired lung function refractory to conventional treatment. During ECMO deoxygenated blood is shunted from the hypoxic infant to an external oxygenating membrane and returned to the arterial circulation allowing the infant's lungs to recover during the by-pass. The right internal jugular vein (RUV) and the right common carotid artery (RCCA) are permanently sacrificed because they are cannulated to gain access to the right atrium and the aorta during ECMO. Although focal brain damage directly related to ligation of the RCCA or RUV has not been consistently noted in surviving neonates who have been treated with ECMO at Thomas Jefferson University Hospital, abnormalities in EEG tracings cranial ultrasound images and CT scans have been frequently noted Cerebral palsy or developmental delay or both have also been noted in a substantial minority or survivors. The cause of the neurologic abnormalities remains uncertain but may be at least in part related to the pre-existing respiratory failure, as has been suggested in studies of ECMO survivors from other centers. In the proposed research, we plan to systematically and prospectively study all infants who are considered possible candidates for ECMO therapy. The temporal relationship of brain electrical, neurosonographic and cerebrovascular abnormalities to respiratory disease and its treatment will be determined by serially repeating EEG, cranial ultrasound and color Doppler imaging studies during and following ECMO or conventional ventilator therapy. Prenatal, intrapartum, and neonatal data will be analyzed and follow-up studies are planned to evaluate the developmental status of all survivors. The purpose of the research is to determine the etiology of the neurologic damage observed in many ECMO survivors. Our long range goals are to develop treatment methods that will prevent brain damage in neonatal infants who are susceptible to hypoxemia from severe respiratory failure.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
1R01NS027463-01
Application #
3413735
Study Section
Human Development and Aging Subcommittee 1 (HUD)
Project Start
1989-08-01
Project End
1992-07-31
Budget Start
1989-08-01
Budget End
1990-07-31
Support Year
1
Fiscal Year
1989
Total Cost
Indirect Cost
Name
Thomas Jefferson University
Department
Type
Schools of Medicine
DUNS #
061197161
City
Philadelphia
State
PA
Country
United States
Zip Code
19107
Goodman, M; Gringlas, M; Baumgart, S et al. (2001) Neonatal electroencephalogram does not predict cognitive and academic achievement scores at early school age in survivors of neonatal extracorporeal membrane oxygenation. J Child Neurol 16:745-50
Gannon, C M; Kornhauser, M S; Gross, G W et al. (2001) When combined, early bedside head ultrasound and electroencephalography predict abnormal computerized tomography or magnetic resonance brain images obtained after extracorporeal membrane oxygenation treatment. J Perinatol 21:451-5
Desai, S A; Stanley, C; Gringlas, M et al. (1999) Five-year follow-up of neonates with reconstructed right common carotid arteries after extracorporeal membrane oxygenation. J Pediatr 134:428-33
Kornhauser, M S; Baumgart, S; Desai, S A et al. (1998) Adverse neurodevelopmental outcome after extracorporeal membrane oxygenation among neonates with bronchopulmonary dysplasia. J Pediatr 132:307-11
Desai, S; Kollros, P R; Graziani, L J et al. (1997) Sensitivity and specificity of the neonatal brain-stem auditory evoked potential for hearing and language deficits in survivors of extracorporeal membrane oxygenation. J Pediatr 131:233-9
Graziani, L J; Baumgart, S; Desai, S et al. (1997) Clinical antecedents of neurologic and audiologic abnormalities in survivors of neonatal extracorporeal membrane oxygenation. J Child Neurol 12:415-22
Baumgart, S; Streletz, L J; Needleman, L et al. (1994) Right common carotid artery reconstruction after extracorporeal membrane oxygenation: vascular imaging, cerebral circulation, electroencephalographic, and neurodevelopmental correlates to recovery. J Pediatr 125:295-304
Graziani, L J; Streletz, L J; Baumgart, S et al. (1994) Predictive value of neonatal electroencephalograms before and during extracorporeal membrane oxygenation. J Pediatr 125:969-75
Graziani, L J; Streletz, L J; Mitchell, D G et al. (1994) Electroencephalographic, neuroradiologic, and neurodevelopmental studies in infants with subclavian steal during ECMO. Pediatr Neurol 10:97-103
Radack, D M; Baumgart, S; Gross, G W (1994) Subependymal (grade 1) intracranial hemorrhage in neonates on extracorporeal membrane oxygenation. Frequency and patterns of evolution. Clin Pediatr (Phila) 33:583-7

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