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Research: Retinal Findings in Neonates with Congenital Diaphragmatic Hernia and Extracorporeal Membrane Oxygenation

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Research: Retinal Findings in Neonates with Congenital Diaphragmatic Hernia and Extracorporeal Membrane Oxygenation

J Pediatr Surg. 2019 Aug 25. pii: S0022-3468(19)30518-4. doi: 10.1016/j.jpedsurg.2019.07.021. [Epub ahead of print]

https://www.ncbi.nlm.nih.gov/pubmed/31575413

Retinal Findings in Neonates with Congenital Diaphragmatic Hernia and Extracorporeal Membrane Oxygenation.

Larsen PP1Kipfmueller F2Holz FG3Reutter H2Müller A2Krohne TU4.

Author information

1Department of Ophthalmology, University of Bonn, Bonn, Germany. Electronic address: petra.larsen@ukb.uni-bonn.de.2Department of Neonatology and Pediatric Critical Care Medicine, University Children’s Hospital Bonn, Bonn, Germany.3Department of Ophthalmology, University of Bonn, Bonn, Germany.4Department of Ophthalmology, University of Bonn, Bonn, Germany. Electronic address: krohne@uni-bonn.de.

Abstract

PURPOSE:

To evaluate the prevalence of retinal pathologies in neonates with congenital diaphragmatic hernia (CDH) receiving extracorporeal membrane oxygenation (ECMO) therapy.

METHODS:

This retrospective study included consecutive infants that received ECMO therapy for CDH at our hospital between 2012 and 2018. Retinal changes were assessed by mydriatic indirect funduscopy. Recorded patient parameters include gestational age (GA), type of delivery, duration of ECMO therapy, duration of inhalative oxygen supplementation, and postmenstrual age at fundus examination.

RESULTS:

Of 54 infants that were treated by ECMO therapy for CDH during the study period, 27 were medically stable enough to receive funduscopic examination and were thus included in the study. Mean GA of these 27 children was 37.3 weeks (range 33.1-40.6) and mean duration of inhalative oxygen supplementation was 12.8 weeks (range 2.7-56.4). Retinal changes were observed in 3 neonates (11.1%). These included multiple midperipheral blot intraretinal hemorrhages in 5 eyes of 3 children and retinopathy of prematurity (ROP) in 2 eyes (stage 3 and stage 2, respectively, without plus disease) of 1 child (GA 35.0 weeks; duration of inhalative oxygen supplementation, 11.9 weeks). In all infants, retinal changes regressed without therapeutic intervention.

CONCLUSIONS:

Neonates treated with ECMO due to CDH may exhibit retinal hemorrhages, however usually without need for intervention. Prematurely born infants receiving ECMO may develop ROP and thus require ROP screening examinations.

TYPE OF STUDY:

Prognosis study.

LEVEL OF EVIDENCE:

Level III.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

CDH; ECMO; Hemodynamics; Oxygenation; ROPPMID: 31575413 DOI: 10.1016/j.jpedsurg.2019.07.021

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