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Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure
Raisa M Schiller1, Dick Tibboel1
1Department of Pediatric Surgery/IC Children and Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
Insights
Children surviving critical neonatal illness face long-term neurocognitive deficits, regardless of treatment like extracorporeal membrane oxygenation (ECMO). Underlying diseases, not treatments, drive these deficits, necessitating tailored long-term care.
Area of Science:
- Neonatal Medicine
- Neuroscience
- Developmental Pediatrics
Background:
- Neonatal critical illness poses a significant risk for long-term neurocognitive deficits in children.
- These deficits can negatively impact academic performance and daily functioning.
- The exact pathophysiological mechanisms are not fully understood.
Purpose of the Study:
- To review and compare neurocognitive outcomes and brain pathology in children following neonatal critical respiratory and cardiac illnesses.
- To investigate potential underlying pathophysiological mechanisms contributing to neurocognitive deficits.
- To discuss neurorehabilitation strategies and long-term care needs.
Main Methods:
- Literature review focusing on neurocognitive outcomes and brain pathology.
- Comparison of outcomes in children treated with and without extracorporeal membrane oxygenation (ECMO).
- Analysis of evidence linking underlying disease processes to neurocognitive deficits.
Main Results:
- Neurocognitive deficits are linked to underlying disease processes, not specific treatments like ECMO.
- Children with complex congenital heart disease and survivors of severe respiratory failure are at high risk.
- Brain pathology findings correlate with neurocognitive outcomes.
Conclusions:
- Long-term neurocognitive deficits after neonatal critical illness are primarily associated with the primary disease, not the treatment modality.
- Early identification and intervention through neurorehabilitation and tailored long-term care are crucial.
- Future research should aim to elucidate underlying mechanisms for preventative strategies.
Abstract:
Over the years, it has become clear that children growing up after neonatal critical illness are at high risk of long-term neurocognitive deficits that impact their school performance and daily life activities. Although the pathophysiological mechanisms remain largely unknown, emerging evidence seems to suggest that long-term neuropsychological deficits following neonatal critical illness are not associated with the type of treatment, such as extracorporeal membrane oxygenation (ECMO), but rather with underlying disease processes. In this review, neurocognitive outcome and brain pathology following neonatal critical respiratory and cardiac illness, either treated with or without ECMO, are described and compared in order to gain insight into potential underlying pathophysiological mechanisms. Putting these findings together, it becomes apparent that both children with complex congenital heart disease and children who survived severe respiratory failure are at risk of neurocognitive deficits later in life. Neurorehabilitation strategies, such as Cogmed working-memory training, are discussed. While prevention of neurocognitive deficits altogether should be strived for in the future, this is not realistic at this moment. It is therefore of great importance that children growing up after neonatal critical illness receive long-term care that includes psychoeducation and personalized practical tools that can be used to improve their daily life activities.
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