358 - Multimodal neuromonitoring modalities of neonatal patients on extracorporeal membrane oxygenation

Publication Number: 358.5829

Allison C. Young, Baylor College of Medicine, Houston, TX, United States; Luna Vorster, University Hospitals of Cleveland / Rainbow Babies & Children's Hospital, Cleveland, OH, United States; James J. Riviello, Baylor College of Medicine, Houston, TX, United States; Duy M. Dinh, Baylor College of Medicine, Houston, TX, United States; Rita Shah, Baylor College of Medicine, Houston, TX, United States; Jennifer Erklauer, Baylor College of Medicine, Houston, TX, United States; Amir H. Navaei, Baylor College of Medicine, Houston, TX, United States; Andrea Ontaneda, Baylor College of Medicine, Houston, TX, United States

Background: Due to the high risk of neurologic complications associated with extracorporeal membrane oxygenation (ECMO) therapy, multimodal neuromonitoring (MNM) is increasingly utilized to detect and minimize neurologic injury.

Objective: This study aims to (i) describe the neonatal intensive care unit (NICU) population requiring ECMO with and without neurologic injury, (ii) summarize the MNM utilized for neonates supported with ECMO, (iii) characterize the neurologic injury of ECMO patients, and (iv) discern the impact of MNM on patient management.

Design/Methods: This retrospective chart review includes all infants admitted to a Level IV NICU at a quaternary care center from 2018-2023 requiring ECMO. Extracted data include patient characteristics, details of neurologic injury, radiographic and electroencephalogram (EEG) findings, near-infrared spectroscopy (NIRS) data, and the effects of MNM on patient management.

Results: Among 53 patients, neuromonitoring modalities included head ultrasound (53/53, 100%), continuous EEG (35/53, 66%), and NIRS (24/53, 45%). The frequency of EEG and NIRS monitoring increased after implementing an institutional MNM protocol. Adverse neurologic events were detected in 18 patients (34%). Among these patients, responses to findings from MNM included additional head imaging (14/18, 78%), change in anticoagulation management (13/18, 72%), and administration of anti-seizure medication (7/18, 39%).

Conclusion(s): MNM during ECMO therapy is necessary for timely detection of evolving neurologic injury and informs patient management. Utilizing a MNM protocol increased the number of neonates receiving continuous neurologic monitoring. Understanding the characteristics of ECMO-associated neurologic injury can further guide MNM protocols.