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Petra Pei Larsen, Florian Kipfmueller, Frank G Holz, Andreas Müller, Tim U. Krohne; Retinal findings in neonates with congenital diaphragmatic hernia and extracorporeal membrane oxygenation. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6530.
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© ARVO (1962-2015); The Authors (2016-present)
Congenital diaphragmatic hernia (CDH) is a malformation of the diaphragm occurring in about 1:4000 live births that can severely affect development of the respiratory system. Extracorporeal membrane oxygenation (ECMO) functions as circulatory and respiratory bypass to prevent irreversible organ dysfunction. Despite improvements in technology, hemostatic complications including hemorrhagic and thrombotic events remain important causes of morbidity and mortality in neonates with ECMO therapy. This study evaluates the prevalence of retinal pathologies in neonates receiving ECMO therapy.
All children born at the Department of Neonatology, University of Bonn, between January 2010 and September 2018 that received ECMO treatment for CDH were included in this study. Mydriatic indirect funduscopy was performed to assess retinal changes, and patient parameters such as gestational age (GA), duration of hospitalization, duration of oxygen supplementation, and post-menstrual age (PMA) at the time of examination were assessed.
A total of 52 neonates received ECMO treatment for CDH during the study period. 28 of these children survived ECMO treatment. Of these, 25 neonates were medically stable enough to receive funduscopic examination and were included in this study. Mean GA of the children was 37.1 weeks (range 33.1 - 40.6 weeks), mean duration of hospitalization 16.8 weeks (range 5.5. - 56.4 weeks), and mean duration of oxygen supplementation 13.8 weeks (range 2.7 - 56.4 weeks). Retinal changes were observed in 3 neonates (12.0 %). These included multiple isolated blot intraretinal hemorrhages in the mid-periphery (4 eyes of 3 children, 12.0 % of children) and retinopathy of prematurity (ROP; 1 eye, 4.0 % of children, stage 3 in zone II without plus disease). For the child with ROP, GA was 35.0 weeks, birth weight was 1330 g, and duration of oxygen supplementation was 83.1 days. In all children, retinal changes regressed without treatment.
Neonates treated with ECMO for CDH may exhibit intraretinal haemorrhages, however usually without need for intervention. Screening for ROP is required in those ECMO-treated infants meeting the established screening criteria.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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