Neonatal Med.  2025 May;32(1):39-48. 10.5385/nm.2025.32.1.39.

Brain Injury and Short-Term Neurodevelopmental Outcomes in Neonates Treated with Respiratory Extracorporeal Membrane Oxygenation: A Single-Center Experience

• Seol KH
• Lee BS
• Yoo K
• Roh JH
• Lee JM
• Kwak JI
• Kim TG
• Park J
• Lee HN
• Kim CY
• Kim SH
• Jeong JY
• Jung E

• KMID: 2568389
• DOI: http://doi.org/10.5385/nm.2025.32.1.39

Abstract

Purpose
This study aimed to characterize the clinical patterns and severity of brain injury in neonates who survived extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory failure during the neonatal period, to evaluate their short-term neurodevelopmental outcomes, and to identify the factors associated with these outcomes.
Methods
We retrospectively reviewed the medical records of neonates who survived ECMO between 2018 and 2024. Based on brain magnetic resonance imaging (MRI) findings, the patients were classified into two groups: no/mild and moderate/severe brain injury. Neurodevelopmental outcomes were assessed at 12–40 months of age using the Bayley Scale of Infant Development II/III and/or the Korean Developmental Screening Test.
Results
Among the 19 neonates included in the study, 18 (94.7%) showed varying degrees of brain injury on MRI (mild: 12, moderate: 1, severe: 5). Neonates with moderate/severe brain injury had significantly longer durations of ECMO support and extended durations of mechanical ventilation and were more likely to receive continuous renal replacement therapy than those with no or mild injury. Developmental delay was identified in 36.8% of survivors and was significantly associated with prolonged mechanical ventilation, longer neonatal intensive care unit stays, and a higher incidence of seizures.
Conclusion
Brain injury is frequently observed on MRI in neonates treated with ECMO. However, its direct association with adverse neurodevelopmental outcomes is not definitive. Since MRI findings alone cannot predict developmental outcomes, clinical and environmental factors should be integrated into prognostic assessments.

Keyword

Extracorporeal membrane oxygenation; Brain injuries; Developmental disabilities; Infant, newborn