Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Extracorporeal membrane oxygenation (ECMO) provides life-saving support for critically ill pediatric patients but carries significant neurological risks. S100B protein, a marker of glial cell damage, may provide valuable prognostic information, yet its utility in pediatric ECMO populations remains understudied
Methods: We retrospectively analyzed 103 pediatric ECMO patients with serum S100B measurements. Primary outcomes included mortality and abnormal head ultrasound (HUS) findings. Secondary analyses examined associations between S100B levels and antiepileptic medication use, time to death, and fold increases in S100B from baseline
Results: Higher maximal S100B levels were significantly associated with increased mortality (AUC = 0.724). Logistic regression demonstrated that each 1 μg/L increase in S100B approximately doubled the odds of death. Patients with abnormal HUS findings showed higher S100B levels compared to those with normal imaging, though limited by sample size. No significant correlations were found between S100B concentrations and antiepileptic medication use or time to death. Among patients with multiple measurements (n=26), fold increases in S100B showed positive but non-significant associations with adverse outcomes
Conclusions: In pediatric ECMO patients, elevated S100B levels demonstrate moderate predictive value for mortality and neurological injury as evidenced by abnormal HUS findings. While promising as a biomarker of brain injury, S100B should be integrated within a comprehensive neuromonitoring approach rather than used in isolation. Larger prospective studies with standardized measurement protocols are needed to validate these findings and establish optimal threshold values for clinical decision-making
