Neonatal myocardial infarction and the role of extracorporeal membrane oxygenation

Ferns, Sunita J.; Khan, Mohammed D.; Firmin, Richard K.; Peek, Giles J.; Bu’Lock, Frances

doi:10.1136/adc.2006.113977

Cited by 12 publications

(14 citation statements)

References 10 publications

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“…In addition to these etiologies, paradoxical embolism from renal vein thrombosis, antithrombin III deficiency, and left ventricular obstructive disease such as aortic stenosis have also been associated with myocardial infarction in the newborn 14–19 …”

Section: Discussionmentioning

confidence: 99%

“…Our patient required ECMO support. The advantage of using ECMO in neonatal myocardial infarction to allow for recovery of left ventricular function has been described in two prior reports 14,15 . Although ECMO is used infrequently in this setting, for the patient with worsening clinical status and cardiac failure despite maximal inotropic support, the role of ECMO may be the best option to allow possible recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Many etiologies for neonatal myocardial infarction have been suggested in the literature, including central line placement, myocarditis, hypercoagulability, and obstructive congenital heart disease 7–13 . Extracorporeal membrane oxygenation (ECMO) has been used in refractory cases 14,15 …”

Section: Introductionmentioning

confidence: 99%

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Neonatal Myocardial Infarction: Case Report and Review of the Literature

Farooqi¹,

Sutton²,

Weinstein³

et al. 2012

Congenit Heart Dis

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Myocardial infarction in a neonate is rare. We describe the case of a full-term male who presented with respiratory distress. A chest radiograph demonstrated cardiomegaly. An electrocardiogram revealed ST segment changes suggestive of ischemia. Cardiac enzymes were elevated and an echocardiogram revealed a regional wall motion abnormality. Cardiac catheterization was performed demonstrating occlusion of the ramus intermedius branch of the left main coronary artery. The patient decompensated, requiring extracorporeal membrane oxygenation (ECMO). The infant was able to be decannulated from ECMO support in 5 days and was ultimately discharged on hospital day 25. We review this case as well as the literature on neonatal myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neonatal Myocardial Infarction: Case Report and Review of the Literature

Farooqi¹,

Sutton²,

Weinstein³

et al. 2012

Congenit Heart Dis

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“…Complete recovery from large and severe myocardial infarctions occurred in a remarkable number of cases [8,15,17,20], which suggests that ECMO may provide myocardial support and promote recovery in non-infarcted areas. Mortality in a single case report was associated with a serum Troponin I of 10.5 ng/mL [19], while an intact survivor supported with ECMO had an initial serum troponin value of 24.72 ng/mL [8]. The predictive value of serum troponin I as contraindication for ECMO remains unclear.…”

Section: Discussionmentioning

confidence: 96%

Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

Ham

Patel

Wise

et al. 2015

Journal of Pediatric Surgery Case Reports

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a b s t r a c tPerinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO) and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn. Ó 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Perinatal asphyxia is a common cause of morbidity and mortality in the newborn period with an incidence between 0.5 and 2% [1,2]. The newborn myocardium is preferentially spared during the early phase of newborn hypoxemia; however, evidence of myocardial injury is present in 29e78% of newborns diagnosed with hypoxic-ischemic encephalopathy (HIE) [3e5]. Global oxygen deprivation, which is suggested by a 5 min Apgar score less than 7, underlies the pathogenesis of myocardial injury in the newborn period [6,7]. Additionally, biomarkers of myocardial injury (i.e. troponin and CK-MB), echocardiographic abnormalities, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality [7]. We present a case of an infant who developed severe myocardial dysfunction following emergent Caesarian delivery for fetal decelarations and was managed with extracorporeal membrane oxygenation (ECMO). We discuss the role of cardiac biomarkers, echocardiography, electrocardiography (ECG), and ECMO in the asphyxiated newborn. Case presentationA 22-year-old G 1 P 0 mother presented to a regional hospital with symptoms of labor at 35 weeks gestation. The perinatal history was significant for insulin-dependent diabetes mellitus and chronic hypertension. A normal anatomic ultrasound was noted, however fetal echocardiography was not performed. Following a trial of labor and poor progression, late decelerations were noted and the infant was delivered by Caesarian section. Upon delivery, the 2,700 g infant appeared floppy without spontaneous respiratory effort and persistent bradycardia. Resuscitative efforts in the delivery room included intubation, ventilation, chest compressions (15 min), multiple fluid boluses, and epinephrine. APGAR scores were 1, 3, and 5 at 1, 5, and 10 min, respectively and an initial arterial blood gas provided evidence of severe metabolic acidosis with a pH of 6.81 and base deficit of À23. The patient was transferred to the in-hospital Level III NICU and was noted to have spontaneous respirations and movement with significant hypoxemia (70e80% saturations on FiO2 of 1.0). However, the patient experienced prolonged bradycardia (60e70 b.p.m.) and a corresponding rhythm strip revealed ST segment elevation. A continuous infusion of epinephrine was initiated and the infant was transferred...

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“…He has compared ECMO with conventional ventilation with clear results showing its benefits. 2 Dr Bu'Lock researches the genetics of congenital heart disease, and the centre has just received a second £1 million grant from the British Heart Foundation for a collaboration with Nottingham University, Nottingham, for the project "Do gene changes cause congenital heart disease?" She says, "This is looking for single nucleotide polymorphisms and copy number variations in specific areas of the genome related to genes such as TBX5 and KX2-5.…”

Section: Emchc Consultants Are Taking Part In a Variety Of Clinical Rmentioning

confidence: 99%

European Perspectives

2010

Circulation

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Neonatal myocardial infarction and the role of extracorporeal membrane oxygenation

Cited by 12 publications

References 10 publications

Neonatal Myocardial Infarction: Case Report and Review of the Literature

Neonatal Myocardial Infarction: Case Report and Review of the Literature

Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

European Perspectives

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