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Published on: August 25, 2014
Neurodevelopmental outcomes in neonatal extracorporeal membrane oxygenation survivors: An institutional perspective
Ashfaque Quadir1,2, Himanshu Popat2,3, Cathryn Crowle2,3
1Helen McMillan Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Insights
One in four infants treated with extracorporeal membrane oxygenation (ECMO) experiences moderate to severe neurodevelopmental impairment. Gross motor and language skills are the most commonly affected developmental domains in these infants.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental pediatrics
- Neonatal intensive care
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for neonates with severe cardiorespiratory failure.
- Neurodevelopmental outcomes in infants following ECMO are a significant concern for long-term health.
- Congenital cardiac disease is a primary indication for ECMO in early infancy.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes of infants who received ECMO support.
- To identify specific developmental domains most affected by ECMO treatment.
Main Methods:
- A cohort of 37 infants surviving ECMO between 2008 and 2018 were assessed.
- The Bayley Scales of Infant and Toddler Development were used to evaluate neurodevelopmental outcomes.
- Developmental impairment was categorized as mild, moderate, or severe based on standard deviations below the test mean.
Main Results:
- Among 29 infants with follow-up at 12 months or older, 10.3% had severe, 13.8% moderate, and 41.3% mild neurodevelopmental impairment.
- Gross motor function was the most affected domain, with 62.1% of patients showing impairment.
- Language impairments, including receptive and expressive, were also prevalent.
Conclusions:
- Approximately 25% of infants treated with ECMO exhibit moderate to severe neurodevelopmental impairment.
- Gross motor and language development are the primary areas impacted following ECMO in early infancy.
- Early identification and intervention are crucial for improving outcomes in this vulnerable population.
Aim:
To describe the neurodevelopmental outcomes following extracorporeal membrane oxygenation (ECMO) in early infancy.
Methods:
Thirty-seven patients who had survived following ECMO support from 2008 to 2018 had their neurodevelopmental outcomes assessed and analysed using the Bayley Scales of Infant and Toddler Development. Developmental outcome was defined as impairment in any of the developmental domains of motor function, cognition and language with mild impairment being 1-2 standard deviations below the test mean, moderate being 2-3 standard deviations below and severe being greater than 3 standard deviations below.
Results:
Of these 37 patients, the median age at admission to Paediatric Intensive Care Unit was 0.4 months (interquartile range 2.8 months) with all of the study patients having an underlying diagnosis of congenital cardiac disease and 37/40 (92.5%) ECMO runs occurring in the immediate post-operative period. Of the 29 patients who had had follow-up at 12 months of age or older, 3 (10.3%) had severe impairment, 4 (13.8%) had moderate impairment, 12 (41.3%) had mild impairment and 10 (34.5%) had no impairment. Gross motor function was most significantly impacted in 18/29 (62.1%) patients, of which 7/18 (38.9%) had severe impairment. This was followed by impairment of receptive language in 8/29 (27.6%) patients and expressive language in 6/29 (20.1%) patients.
Conclusions:
One in four infants undergoing ECMO treatment in early infancy has moderate to severe neurodevelopmental impairment. Gross motor and language are the most affected developmental domains.
