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Published on: December 4, 2013
Growing Up After Critical Illness: Verbal, Visual-Spatial, and Working Memory Problems in Neonatal Extracorporeal
Marlous J Madderom1, Raisa M Schiller, Saskia J Gischler
11Intensive Care Unit, Department of Pediatric Surgery Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. 2Department of Neonatology Radboud University Medical Center, Nijmegen, The Netherlands.
Insights
Neonatal extracorporeal membrane oxygenation survivors show lasting challenges in verbal, visual-spatial, and working memory. Further research is needed to understand risk factors and improve outcomes for these adolescents.
Area of Science:
- Neuroscience
- Pediatric Medicine
- Psychology
Background:
- Neonatal extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for critically ill newborns.
- Long-term neurodevelopmental outcomes in adolescent survivors of neonatal ECMO require thorough investigation.
Purpose of the Study:
- To evaluate the neuropsychological status of 17- and 18-year-old individuals who survived neonatal ECMO.
- To identify potential predictors of adverse neuropsychological outcomes in this cohort.
Main Methods:
- A prospective longitudinal follow-up study was conducted.
- Thirty adolescents (17-18 years old) treated with ECMO between 1991 and 1997 underwent comprehensive neuropsychological assessments.
- Validated instruments were used to evaluate attention, memory, executive functioning, visual-spatial skills, social-emotional functioning, and behavior.
Main Results:
- Survivors exhibited significantly lower performance compared to norms in short-term and long-term verbal memory, visual-spatial memory, and working memory.
- Parents reported increased difficulties with organization and behavior evaluation.
- Adolescents reported more withdrawn/depressed behavior, somatic complaints, and social problems, alongside positive self-esteem.
Conclusions:
- Adolescents treated with neonatal ECMO are at elevated risk for specific memory deficits.
- Future research should address longitudinal outcomes, risk factor identification, the impact of illness severity on brain injury, and the efficacy of cognitive rehabilitation.
Objectives:
To assess neuropsychologic outcome in 17- and 18-year-old neonatal extracorporeal membrane oxygenation survivors.
Design:
A prospective longitudinal follow-up study.
Setting:
Follow-up program at the Erasmus MC-Sophia Children's Hospital in Rotterdam, The Netherlands.
Patients:
Thirty adolescents 17 or 18 years old, treated between 1991 and 1997, underwent neuropsychologic assessment.
Interventions:
None.
Measurements And Main Results:
Attention, memory, executive functioning, visual-spatial functions, social-emotional functioning, and behavior were assessed with validated instruments, and data were compared with reference data. Included predictors for analysis of adverse outcome were diagnosis, age at start extracorporeal membrane oxygenation, convulsions, and use of antiepileptics. Adolescents' performance (expressed as mean [SD] z score) was significantly lower than the norm on short-term and long-term verbal memory (z score = -1.40 [1.58], p = 0.016; z score = -1.54 [1.67], p = 0.010, respectively), visual-spatial memory (z score = -1.65 [1.37], p = 0.008; z score = -1.70 [1.23], p = 0.008, respectively), and working memory (32% vs 9% in the norm population). Parents reported more problems for their children regarding organization of materials (z score = -0.60 [0.90]; p = 0.03) and behavior evaluation (z score = -0.53 [0.88]; p = 0.05) on a questionnaire. Patients reported more withdrawn/depressed behavior (z score = -0.47 [0.54]; p = 0.02), somatic complaints (z score = -0.43 [0.48]; p = 0.03), and social problems (z score = -0.41 [0.46]; p = 0.04). Patients reported more positive feelings of self-esteem and an average health status.
Conclusions:
Adolescents treated with neonatal extracorporeal membrane oxygenation are at risk of verbal, visual-spatial, and working memory problems. Future research should focus on 1) the longitudinal outcome of specific neuropsychologic skills in adolescence and adulthood; 2) identifying risk factors of neuropsychologic dysfunction; 3) evaluating to what extent "severity of illness" is responsible for acquired brain injury; and 4) effects of timely cognitive rehabilitation.
