Cerebral Near-Infrared Spectroscopy and Brain Injury in Neonates on Extracorporeal Membrane Oxygenation: Single-Center Retrospective Cohort, 2018–2024

OBJECTIVES: To evaluate the association between cerebral near-infrared spectroscopy (NIRS)-derived parameters and moderate-to-severe brain injury in neonates supported with extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective cohort study. SETTING: Single tertiary neonatal ICU (NICU) in Korea. PATIENTS: Neonates admitted to the NICU (from November 2018 to June 2024) undergoing ECMO with cerebral NIRS monitoring. Neonates with cardiac arrest before ECMO initiation were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We reviewed the medical records of 33 neonates with a median (interquartile range [IQR]) gestational age of 38.1 weeks (IQR, 37.5-38.7 wk) and birth weight of 2938 g (IQR, 2585-3360 g). Brain injury severity was classified according to neuroimaging reports using cerebral MRI and head ultrasound scans (HUS). Patients were divided into a normal-to-mild brain injury group (20/33) and a moderate-to-severe injury group (13/33). Compared with the normal-to-mild injury group, moderate-to-severe brain injury was associated with lower minimum regional cerebral oxygen saturation (rSco2; median 20% vs. 46%; p = 0.016), longer duration with rSco2 less than 50% (median, 48.0 vs. 3.5 hr; p = 0.029), prolonged periods of rSco2 decline greater than 20% from baseline (median 80.0 vs. 20.0 hr; p = 0.027), and higher cumulative hypoxia burden (median, 407.0 vs. 6.0%·hr; p = 0.034). The receiver operating characteristic curve analysis identified thresholds associated with moderate-to-severe brain injury as follows: minimum rSco2 of 21%, duration of rSco2 less than 50% of 44 hours, duration of rSco2 decline greater than 20% of 46 hours, and cumulative hypoxia burden of 320%·hours. CONCLUSIONS: In this 2018-2024 cohort, cerebral NIRS parameters were associated with moderate-to-severe brain injury identified using MRI and HUS. Lower rSco2 and greater desaturation exposure were associated with the presence of moderate-to-severe injury by discharge. The potential for early risk stratification of neonates on ECMO requires confirmation in prospective studies.