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Published on: April 19, 2024
Prospective longitudinal evaluation of lung function during the first year of life after extracorporeal membrane
Ward Hofhuis1, Manon N Hanekamp, Hanneke Ijsselstijn
1Department of Pediatrics, Division of Pediatric Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Infants receiving extracorporeal membrane oxygenation (ECMO) show normal lung volumes in their first year. Forced expiratory flow remains stable but below average, suggesting ECMO may protect lung function in critically ill neonates.
Area of Science:
- Neonatal care
- Pediatric pulmonology
- Extracorporeal membrane oxygenation (ECMO) research
Background:
- Longitudinal data on infant lung function post-ECMO is limited.
- Understanding the long-term respiratory impact of ECMO is crucial for neonatal care.
Purpose of the Study:
- To track lung function in infants during the first year after ECMO.
- To explore links between lung function and perinatal factors in this cohort.
Main Methods:
- Prospective longitudinal cohort study design.
- 64 infants undergoing ECMO for various conditions were evaluated at 6 and 12 months.
- Lung function measured included functional residual capacity and forced expiratory flow.
Main Results:
- Infants maintained normal lung volumes (z-scores near 0) at 6 and 12 months.
- Forced expiratory flow was consistently below average (z-scores around -1.1 to -1.2, p < .001).
- Infants with congenital diaphragmatic hernia showed significantly above-normal lung volumes at 12 months.
Conclusions:
- ECMO-treated infants exhibit normal lung volumes and stable, albeit reduced, expiratory flows within the first year.
- ECMO may mitigate lung injury from mechanical ventilation or preserve lung function in neonates.
- Further research is needed to fully elucidate the protective mechanisms of ECMO on neonatal lung development.
Objective:
To collect longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation and to evaluate relationships between lung function and perinatal factors. Longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation are lacking.
Design:
Prospective longitudinal cohort study.
Setting:
Outpatient clinic of a tertiary level pediatric hospital.
Patients:
The cohort consisted of 64 infants; 33 received extracorporeal membrane oxygenation for meconium aspiration syndrome, 14 for congenital diaphragmatic hernia, four for sepsis, six for persistent pulmonary hypertension of the neonate, and seven for respiratory distress syndrome of infancy. Evaluation was at 6 mos and 12 mos; 39 infants were evaluated at both time points .
Interventions:
None.
Measurements And Main Results:
Functional residual capacity and forced expiratory flow at functional residual capacity were measured and expressed as z score. Mean (sem) functional residual capacities in z score were 0.0 (0.2) and 0.2 (0.2) at 6 mos and 12 mos, respectively. Mean (sem) forced expiratory flow was significantly below average (z score = 0) (p < .001) at 6 mos and 12 mos: -1.1 (0.1) and -1.2 (0.1), respectively. At 12 mos, infants with diaphragmatic hernia had a functional residual capacity significantly above normal: mean (sem) z score = 1.2 (0.5).
Conclusions:
Infants treated with extracorporeal membrane oxygenation have normal lung volumes and stable forced expiratory flows within normal range, although below average, within the first year of life. There is reason to believe, therefore, that extracorporeal membrane oxygenation either ameliorates the harmful effects of mechanical ventilation or somehow preserves lung function in the very ill neonate.
