Neonatal critical illness and development: white matter and hippocampus alterations in school‐age neonatal extracorporeal membrane oxygenation survivors
Open accessAbstract
Aim: To examine the neurobiology of long‐term neuropsychological deficits after neonatal extracorporeal membrane oxygenation (ECMO). Method: This cross‐sectional study assessed white matter integrity and hippocampal volume of ECMO survivors (8–15y) and healthy children (8–17y) using diffusion tensor imaging (DTI) and structural magnetic resonance imaging (MRI) respectively. Neuropsychological outcome was evaluated in ECMO survivors. Included clinical predictors of white matter integrity: age start ECMO, ECMO duration, highest oxygenation index before ECMO, highest mean airway pressure, and mechanical ventilation duration. Results: ECMO survivors (n=23) had lower global fractional anisotropy than healthy children (n=54) (patients=0.368; comparison group=0.381; p=0.018), but similar global mean diffusivity (p=0.410). ECMO survivors had lower fractional anisotropy in the left cingulum bundle (ECMO survivors=0.345; comparison group=0.399; p<0.001) and higher mean diffusivity in a region of the left parahippocampal cingulum (patients=0.916; comparison group=0.871; p<0.001). Higher global mean diffusivity predicted worse verbal memory in ECMO survivors (n=17) (β=–0.74, p=0.008). ECMO survivors (n=23) had smaller bilateral hippocampal volume than healthy children (n=43) (left, p<0.001; right, p<0.001) and this was related to worse verbal memory (left, β=0.65, p=0.018; right, β=0.71, p=0.006). Interpretation: Neonatal ECMO survivors are at risk for long‐term brain alterations, which may partly explain long‐term neuropsychological impairments. Neuroimaging may contribute to better risk stratification of long‐term impairments.
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Neonatal complications can lead to cingulum bundle diffusion changes.
“Further support comes from the finding that neonatal complications, a common risk factor for many neuropsychiatric conditions, can lead to cingulum bundle diffusion changes (Schiller et al., 2017a,b).”
From The cingulum bundle: Anatomy, function, and dysfunction (2018) · cites this paper as Schiller et al., 2017a,b
The DTI results report lower fractional anisotropy in the left cingulum bundle of school-age children who survived neonatal ECMO than in controls. This supports a cingulum diffusion difference after a specific neonatal critical illness, but the cross-sectional comparison does not establish that neonatal complications generally cause such changes. No page number is provided in our copy. (LLM, conf=0.85)
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The cingulum bundle: Anatomy, function, and dysfunction
Bubb, E. J., Metzler-Baddeley, C., & Aggleton, J. P. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.05.008 · Cited by 740 · see citing works
“Further support comes from the finding that neonatal complications, a common risk factor for many neuropsychiatric conditions, can lead to cingulum bundle diffusion changes (Schiller et al., 2017a,b).”
Background
- Authors
- Schiller, R. M., van den Bosch, G. E., Muetzel, R. L., Smits, M., Dudink, J., Tibboel, D., Ijsselstijn, H., & White, T.
- Affiliations
- Erasmus MC - Sophia Children’s Hospital (NL)
- Intensive Care and Department of Pediatric Surgery Erasmus MC‐Sophia Children's Hospital Rotterdam The Netherlands
- Erasmus MC (NL)
- Corresponding author
- White, Tonya
- ORCID
- Venue
- Developmental Medicine & Child Neurology
- Publisher
- Wiley
- Published
- 2016-11-21
- Volume
- 59
- Issue
- 3
- Pages
- 304-310
- ISSN
- 0012-1622 (ISSN-L)
- 1469-8749
- OpenAlex
- W2556262735
- Cited by
- 30
- References
- 3
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2022: 5 · 2021: 5 · 2020: 1 · 2019: 3 · 2018: 6 · 2017: 5
- FWCI
- 5.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Developmental Medicine & Child Neurology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Funders
- ZonMw (TOP 91211021)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- neonatal extracorporeal membrane oxygenation, ECMO survivors, white matter integrity, hippocampal volume, fractional anisotropy, mean diffusivity, cingulum, verbal memory, neuropsychological deficits, long-term neurodevelopmental outcomes, risk stratification
- MeSH terms
- Adolescent, Analysis of Variance, Child, Developmental Disabilities, Cognition Disorders, Cross-Sectional Studies, Female, Hippocampus, Humans, Image Processing, Computer-Assisted, Male, Neuropsychological Tests, Retrospective Studies, Extracorporeal Membrane Oxygenation, Critical Illness, Survivors, Diffusion Tensor Imaging, White Matter
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