Life support for babies - NEST

The clinical question

Babies with severe heart or lung failure need life support to help circulate oxygen-rich blood around their body. This can involve a treatment called extracorporeal membrane oxygenation (ECMO), where a machine outside the body takes over the function of the lungs and the heart.

ECMO is the most effective form of life support for babies with severe heart and lung failure. But the rates of disability in children who have undergone this treatment remain high. It’s thought that ECMO could affect the blood supply to the brain. This may might contribute to brain injury and long-term problems with brain function and development. 

‘Mild therapeutic hypothermia’, where the body temperature is lowered by a small amount (from 37 degrees Celsius to 34 degrees Celsius), has been shown to protect the newborn brain in other conditions. The BHF funded the ‘Neonatal ECMO Study of Temperature’ (NEST) trial, led by Professor David Field at Glenfield Hospital, Leicester. This study tested whether mild therapeutic hypothermia could limit damage to the brain of newborn babies receiving ECMO. The hope was that this could help to reduce problems with brain function as they got older.

What did the study involve?

Started in 2005, the NEST trial recruited 111 newborn babies referred for ECMO at centres across the UK. The babies were randomly allocated to either:

• Receive ECMO at normal body temperature (37 degrees Celsius).
• Have their body temperature cooled to 34 degrees Celsius for the first 48 to 72 hours of their ECMO treatment. This was followed by gradual rewarming.

At 2 years of age, babies in both groups had their brain development and function monitored.

What did the study show?

• Newborn babies who received ECMO with mild cooling did not show any improvement in their brain function.
• The mean scores for thinking, language and movement control at 2 years were slightly lower in the ECMO-with-cooling group compared with the no-cooling group.

Why is the study important?

This study involved recruiting severely ill newborns into a clinical trial at a time of great parental anxiety. Its successful completion was a testament to the fortitude of the parents, who allowed their children to take part, and the efforts of the trial team. 

It had long been debated whether therapeutic hypothermia could protect the brain of newborn babies receiving ECMO. The NEST trial provided important evidence that cooling is not beneficial in this situation. 

He added: “This trial also helped to avoid the routine introduction of an intervention which would otherwise have complicated the care of these children, for no benefit.”

Study details

"Neonatal ECMO Study of Temperature (NEST) - randomised trial to assess the neuro protective effect of mild cooling in neonates receiving extra corporeal membrane oxygenation"
Award reference: SP/04/004/18146
Principal Investigator: Professor David Field, University of Leicester

Publication details

Field D, Juszczak E, Linsell L, et al. Neonatal ECMO study of temperature (NEST): a randomized controlled trial. Pediatrics. 2013;132(5):e1247-56.