Retinal Findings in Neonates with Congenital Diaphragmatic Hernia and Extracorporeal Membrane Oxygenation
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In brief
In brief
Retrospective study of 27 neonates with CDH receiving ECMO found 11% developed retinal changes, including intraretinal hemorrhages and mild ROP, all resolving without intervention. Findings suggest routine funduscopic screening is warranted for premature infants on ECMO, though most retinal pathology is self-limiting.
Written by the GCMD Library team from the article.
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.