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Psychological outcome of ECMO-eligible neonates with severe respiratory failure treated using conventional medical
J L Mathias1, S M Clark, T Nettelbeck
1Department of Psychology, University of Adelaide, South Australia.
Insights
Conventional medical therapy for neonates with respiratory failure shows good outcomes, suggesting a 19% mortality and 18% morbidity rate. Extracorporeal membrane oxygenation (ECMO) eligibility criteria may need revision based on these findings.
Area of Science:
- Neonatal care
- Pediatric respiratory medicine
- Medical technology assessment
Background:
- National Health and Medical Research Council (NHMRC) recommended investigating outcomes of conventional treatment for neonatal respiratory problems.
- Prior to establishing new extracorporeal membrane oxygenation (ECMO) centers in Australia, further data on conventional treatment efficacy was needed.
Purpose of the Study:
- To assess the cognitive and behavioral outcomes of infants treated conventionally for respiratory problems.
- To inform decisions regarding the expansion of extracorporeal membrane oxygenation (ECMO) services in Australia.
Main Methods:
- Evaluated 18 infants (index group) aged 1.5-3 years who received conventional treatment for respiratory issues at birth.
- Compared index infants to a matched control group without major birth complications.
- Utilized Bayley or McCarthy scales of infant development and the Child Behavior Checklist for assessments.
Main Results:
- Conventional medical therapy for neonates with severe respiratory failure, meeting extracorporeal membrane oxygenation (ECMO) criteria, demonstrated a 19% mortality rate.
- Psychological morbidity was observed in 18% of infants treated conventionally.
- These results suggest a favorable prognosis for infants receiving conventional treatment.
Conclusions:
- Conventional treatments for neonatal respiratory failure have improved, leading to better outcomes.
- Current extracorporeal membrane oxygenation (ECMO) eligibility criteria may require revision.
- Accurate identification of infants at extreme risk of mortality with conventional therapy is crucial.
Objective:
The present study addressed a National Health and Medical Research Council (NHMRC) recommendation that the outcome of neonates who are treated conventionally for respiratory problems be further investigated before setting up additional extracorporeal membrane oxygenation (ECMO) centres in Australia.
Methodology:
The cognitive and behavioural outcome of ECMO eligible infants who received conventional treatment for respiratory problems at birth was assessed in 18 infants aged 1.5-3 years (index group). ECMO was not available at either of the treating hospitals. Index children were compared to a matched control group of children who did not experience any major complications at birth. Children were assessed using either the Bayley or McCarthy scales of infant development and the Child Behavior Checklist.
Results:
Overall, a mortality rate of 19% and a psychological morbidity rate of 18% suggest that children born with severe respiratory failure, who meet existing ECMO eligibility criteria, have a good prognosis when treated using conventional medical therapy.
Conclusions:
Improvements to conventional treatments indicate that ECMO eligibility criteria may need to be revised to identify accurately those infants who are at extreme risk of mortality if treated conventionally.