Intracranial hemorrhage in premature neonates treated with extracorporeal membrane oxygenation correlates with conceptional age

Abstract

Objective: To determine the effect of patient age on the risk of intracranial hemorrhage (ICH) in premature neonates treated with extracorporeal membrane oxygenation (ECMO).

Study design: This was a retrospective cohort study of neonates of <37 weeks' gestation treated with ECMO in the years 1992 through 2000 and reported to the Extracorporeal Life Support Organization Registry (n=1524). The relation between ICH and patient age, defined as gestational age, postnatal age (PNA), and postconceptional age (PCA), was determined with the use of multiple logistic regression analysis.

Results: PNA was inversely correlated with ICH in the univariate analysis (P=.01) but not in the multivariate analysis (P=.36). PCA showed a strong univariate correlation with decreasing ICH: 26% of patients </=32 weeks' PCA developed ICH as compared with 6% of patients with PCA of 38 weeks (P=.004). Multiple logistic regression identified as independent predictors of ICH: PCA (P=.005), sepsis (P=.004), acidosis (P=.0004), and treatment with sodium bicarbonate (P=.002). Gestational age was correlated with ICH in the multivariate model only when PNA was included.

Conclusions: Postnatal age is not a strong independent predictor of ICH in premature neonates treated with ECMO. PCA is the best age-related predictor of ECMO-related ICH in premature infants.