Elsevier

The Journal of Pediatrics

Volume 127, Issue 3, September 1995, Pages 447-457
The Journal of Pediatrics

Neurodevelopmental status at age five years of neonates treated with extracorporeal membrane oxygenation,☆☆,,★★

https://doi.org/10.1016/S0022-3476(95)70082-XGet rights and content

Abstract

Objective: To determine the neurodevelopmental status at age 5 years among children who received extracorporeal membrane oxygenation (ECMO) in the newborn period as a treatment for severe cardiorespiratory failure. Methods: We conducted a prospective cohort study of 103 five-year-old ECMO-treated children born between June 1984 and July 1988, and treated at our institution. Thirty-seven healthy control children were recruited locally. The assessment protocol included a complete neuropsychologic assessment, psychosocial assessment with parent questionnaires, a standard neurologic evaluation, assessment of gross motor and fine motor function, a medical history, and physical examination. Results: Major disability was present in 17 of the ECMO cohort. Eleven ECMO-treated children (11) were mentally retarded, one of whom was profoundly impaired. Two additional children had severe learning disabilities. Cerebral palsy was diagnosed in 5 (5%) ECMO-treated children, but all cases were mild in nature and the patients were walking unaided. One child has paraplegia. The mean Full Scale, Verbal, and Performance IQs of the ECMO-treated children were within the normal range, but as a group were significantly lower than in control children (96 vs 115, p <0.001). Children treated with ECMO had increased risk relative to the control children for academic difficulties at school age (49% vs 22%, p <0.01) and a higher rate of behavioral problems reported by parents (42% vs 16%, p = 0.01). Conclusions: The rate of major disability was comparable to that in other high-risk populations. The high rate of behavioral problems and increased risk of subsequent school failure among nonretarded ECMO-treated children supports the need for close follow-up of these children after hospital discharge. (J PEDIATR 1995;127:447-57)

Section snippets

Subjects

From June 1984 until July 1988, 204 neonates were treated with ECMO in the neonatal intensive care unit at Children's National Medical Center. All infants were outborn and transported to our institution from states within a perimeter that included Maine, Florida, and Ohio. Cardiopulmonary bypass was initiated when an infant failed to respond to medical management and met criteria of cardiorespiratory failure that predicted an 80% mortality rate.18, 19 Details of the ECMO procedure have been

Neurodevelopmental outcome: Major disability

Seventeen ECMO-treated children (17%) had one or more major disabilities: mental disability, motor disability, sensorineural impairment, or seizure disorder.

DISCUSSION

This report summarizes neurodevelopmental sequelae of 103 ECMO-treated neonates at 5 years of age, compared with a control group of 37 five-year-old children with normal birth histories. Given the mortality risk in the neonatal period, the presumed perturbations in cerebral blood flow, and the high rate of neuroimaging abnormality, the 17% rate of major disability among the ECMO survivors is lower than might be expected; however, parental reports of behavioral problems and the risk of academic

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      Citation Excerpt :

      The long-term neurologic outcomes of pediatric ECMO survivors have been widely studied over the past 2 decades. Several groups have identified gross motor delays in elementary school age children and ongoing neuropsychological deficits, such as spatial ability, memory, and working speed, through adolescence.116–118 It is imperative to note that the neurodevelopmental assessments of children in these follow-up studies were compared with normal reference ranges.

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    From the Center for Child Development, Departments of Behavioral Sciences, Psychology, Neurology, and Neonatology, and the Children's Research Institute, Children's National Medical Center, and the Departments of Pediatrics and Neurology, George Washington University, Washington, D.C.

    ☆☆

    Supported in part by a grant (RO1:NS26805) from the National Institute of Neurological Disorders and Stroke, National Institutes of Health (Dr. Glass).

    Reprint requests: Penny Glass, PhD, Director, Center for Child Development, Children's National Medical Center, Washington, DC 20010.

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    0022-3476/95/$3.00 + 0 9/23/65708

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