Methods: Using data from the Extracorporeal Life Support Organization (2000-2009), we computed the survival to hospital discharge for neonates (age <= 30 days) supported with ECMO after stage 1 palliation for hypoplastic left heart syndrome. The factors associated with mortality were evaluated using multivariate logistic regression analysis.
Results: Among 738 neonates, the survival rate was 31%. The median age at cannulation was 7 days (interquartile range, 4-11). Black race (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.6), mechanical ventilation before ECMO(>15-131
hours: OR, 1.6; 95% CI, 1.1-2.4; > 131 hours: OR, 1.9; 95% CI, 1.3-2.9), use of positive end expiratory pressure (>6-8 cm H2O: OR, 1.7; 95% CI, 1.1-2.7; >8 cm H2O: OR, 1.9; 95% CI, 1.2-3.1), and longer ECMO duration (per day, OR, 1.2; check details 95% CI, 1.1-1.3) Selleckchem PLX3397 increased mortality. ECMO support for failure to wean from cardiopulmonary bypass (OR, 1.6; 95% CI, 1.02-2.4) also decreased survival. ECMO complications, including renal failure (OR, 1.9; 95% CI, 1.2-3.1), inotrope requirement (OR, 1.5; 95% CI, 1.1-2.1), myocardial stun (OR, 3.2; 95% CI, 1.3-7.7), metabolic acidosis (OR, 2.9; 95% CI, 1.3-6.7), and neurologic injury (OR, 1.7; 95% CI, 1.1-2.6), during support also increased mortality.
Conclusions: Mortality for neonates with hypoplastic
left heart syndrome supported with ECMO after stage 1 palliation is high. Longer ventilation before cannulation, longer support duration, and ECMO CYTH4 complications increased mortality.
(J Thorac Cardiovasc Surg 2012; 144:1337-43)”
“Several studies have revealed the importance of brain imaging in term and preterm infants. The aim of this retrospective study was to review safety, handling, and image quality of MR brain imaging using a new 3 Tesla MR-compatible incubator.
Between 02/2011 and 05/2012 100 brain MRIs (84 infants, mean gestational age 32.2 +/- 4.7 weeks, mean postmenstrual age at imaging 40.6 +/- 3.4 weeks) were performed using a 3 Tesla MR-compatible incubator with dedicated, compatible head coil. Seventeen examinations (13 infants, mean gestational age 35.1 +/- 5.4 weeks, mean postmenstrual age at imaging 47.8 +/- 7.4 weeks) with a standard head coil served as a control. Image analysis was performed by a neuroradiologist and a pediatric radiologist in consensus.
All but two patients with known apnea were transferred to the MR unit and scanned without problems. Handling was easier and faster with the incubator; relevant motion artifacts (5.9 vs. 10.8 %) and the need for repetitive sedation (43.0 vs. 86.7 %) were reduced. Considering only images not impaired by motion artifacts, image quality (4.8 +/- 0.4 vs. 4.3 +/- 0.8, p = 0.047) and spatial resolution (4.7 +/- 0.4 vs. 4.2 +/- 0.6, p = 0.011) of T2-weighted images were scored significantly higher in patients imaged with the incubator. SNR increased significantly (171.6 +/- 54.5 vs.