A longitudinal, prospective study was conducted to determine the long-term neurodevelopmental outcome in neonatal extracorporeal membrane oxygenation (ECMO) survivors with and without seizures. One hundred sixty-two ECMO survivors from March 1985 until November 1995 were eligible for follow-up. Sixty-four returned at preschool age (4-6 years). Thirty-nine infants did not experience neonatal seizures (group 1); however, 25 exhibited seizures before or during ECMO (group 2). Twelve infants referred for ECMO, but managed medically, served as a clinical comparison group (group 3). At school age (7-9 years), 32 ECMO children (16 with seizures) returned for neuropsychologic evaluation. The results indicated that the preschool seizure group (group 2) demonstrated a significantly lower mean IQ than group 1 or 3 (P = .002). Furthermore, 56% of group 2 had IQ scores < or =84 (> or =1 SD below the mean). Group 2 also exhibited significantly higher rates of cerebral palsy (P < or = .001) and speech-language disorder than group 1 or 3 (P < .001). At school age, the seizure group continued to perform below average on intelligence testing, with 50% scoring < or =84 and 38% receiving special education. This study extends the previous findings that seizures associated with neonatal ECMO are a primary risk factor for neurodevelopmental sequelae and confirms the need for long-term follow-up to assist with academic programming.
The use of surfactant replacement, ‘kinder gentler’ modes of ventilation combined with prenatal corticosteroids have all played a role in improved survival rates of very-low-birth-weight infants but have not reduced the prevalence of chronic lung disease. The increased rates of prematurity being observed in the United States along with the increased survival makes the overall problem of treatment of infants with established disease expensive spanning neonatology, pediatric critical care and general pediatrics and involving a myriad of specialists over the life of the surviving infant. However, none of the therapies used over the years have proven to be effective or have long-term adverse effects, nor have they been accepted as methods to prevent chronic lung disease. Although intuitively an appropriate nutritional therapy may be a useful adjunct in the care of the premature sick infant, perinatal malnutrition remains a major problem. The role of nutrition therapy in health and disease as it pertains to the lung will be reviewed.
Nutrition for sick newborn infants, both term and preterm, has been evolving since the first published report of use of total parenteral nutrition (TPN) in an infant. The more preterm infants have posed an even greater challenge, because optimal timing for use of enteral nutrition is an additional factor for completing their nutritional demands. Although benefiting the immune system among other physiological benefits, human milk has many nutritional gaps for the premature infant. The development of premature infant formulas and milk fortifiers has helped fill these gaps, but questions still exist about safety and efficacy of human milk versus formula. This article will focus on the use of TPN as well as early initiation of enteral feedings and the challenges this brings.
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