Hypothermia During ECMO to Decrease Brain Injury

Inclusion Criteria: * Neonates ≥ 34 weeks gestational age and postnatal age ≤ 28 days * Presence of severe reversible NHRF qualifying for ECMO based on institutional guidelines including: * Oxygenation Index \> 35 (\[mean airway pressure in cmH2O x Fractional inspired O2 concentration x 100\]/Arterial O2 tension in mmHg) or * Alveolar-arterial oxygen gradient \> 600 mmHg for 4 h * Infants undergoing veno-arterial or veno-venous ECMO Exclusion Criteria: * Lethal chromosomal and congenital anomalies including congenital diaphragmatic hernia (CDH) Infants with CDH, who constitute a third of neonates undergoing ECMO, have been excluded because the high mortality and morbidity is related more to the underlying lung abnormality and practice variation in timing of CDH repair rather than to NHRF. * ECMO for post operative cardiac support * Neonates with a birth weight \< 1.8 kg * Initiation of HYP for NE prior to initiating ECMO for NHRF