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

Abstract

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