Extra corporeal membrane oxygenation (ECMO) i s a heart-lung bypass procedure which involves permanent ligation of the right common carotid artery and internal jugular vein. 18 children who received ECMO as neonates f o r severe cardiorespiratory insufficiency were studied neurologically 4-11 years a f t e r treatment. Cognitive and/or language impairments were noted in 5/18 whereas 72% had a normal neurodevelopmental status. Spastic motor impairment was mild in 3 and severe in 2 patients. Five children had paroxysmal discharges on the EEG but lateralizing findings were not seen in any child. In 10/11 patients studied by noninvasive carotid evaluation, the a r t e r i a l occlusion could be identified by ultrasound. In these cases the internal carotid artery (ICA) was patent and forward flow in the ICA was achieved by retrograde channeling through the external carotid artery. The size and volume of flow in the right ICA was approximately 50% of that in the l e f t . Asymmetrical auditory cortical evoked potentials were seen in 60% of the 12 cases studied t o date with right sided proponderance in the majority. These preliminary findings suggest a poss i b l e subclinical effect upon right hemispheral function ipsilateral t o the a r t e r i a l ligation. W e conclude that: 1)collateral retrograde flow i s established a f t e r right common carotid artery liqation a t birth and 2)in the majority of patients there are no apparent specific clinical symptoms of right hemispheral dysfunction following the ECMO procedure. Conclusions: Scapular retractions are common, but resolve by 12 months in most preterm infants. SR interfere with performance at 6 months, but as SR resolve, no lasting effects on development are seen. Physical therapy or exercises may help to promote resolution of this relatively common abnormality in preterm infants.
DEVELOPMENTAL SIGNIFICANCE OF
DIRECT MEASUREMENT OF LOCAL CEREBRAL BLOOD FLOW (1CBF) IN THE GREYHOUND:Possible Relationship to Intraventricular Hemorrhage in the Newborn. KH Manwaring, TJ Tarby, HW Pittman, and WJ Daily, Barrow Neurological Institute, Phoenix, ArizonaThe pathogenesis of neonatal periventricular-intraventricular hemorrhage (PVH-IVH) remains unclear, although an aberration in cerebral hemodynamics imposed upon prematurity appears fundamental.Microthermistors were implanted in the cerebral cortex of 17 adult greyhounds.An analog-digital hybrid system developed using the IBM PC computer to provide simultaneous continuous lCBF data at four discrete sites.Variables of peak inspiratory pressure (PIP), positive and expiratory pressure (PEEP), total minute ventilation and pulse pressure were investigated through a 1 mm burr hole as well as 2 cm craniotomy to compare cranial compliance effects.Positive Asphyxia, with its attendant hypotension, is the most corranon cause f o r neonatal cerebral infarction. We have demonstrated uncoupling of cerebral blood flow & metabolism i n a hemorrhagic hypotension(HH) model for cerebral infarction i n the newborn beagle pup. We report the e ...
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