No abstract

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.

No abstract

The hospital and clinic records of 230 neonates with ABO hemolytic disease (HD) were reviewed. There was no significant difference in clinical severity between AO-HD and BO-HD as measured by (1) number of neonates with hyperbilinibinemia and/ or those requiring exchange transfusion; (2) hemoglobin concentration; (3) reticulocyte count; (4) bilirubin concentration; and (5) incidence of anemia after discharge from the hospital. There was no difference in the hemoglobin concentrations measured at between four and eight weeks of age in 39 control infants and infants with either AO-HD or BO-HD who did not require an exchange transfusion. Our data do not indicate a clinical difference in the severity of AO-HD and BO-HD. Infants with ABO-HD who do not require exchange transfusion and/or phototherapy and whose hemoglobin concentration at discharge is &gt; 15 gm/dl do not need a hemoglobin measurement before 6 weeks of age.

The need for exchange transfusion was analyzed retrospectively using several different methods (total bilirubin binding capacity, birth weight, plasma protein level, and two published charts). These predictive methods were applied to 175 jaundiced infants for whom all the data were available and to 19 infants who were actually exchanged. Most of the patients were sick, premature infants. This study demonstrates the lack of agreement among the predictive methods.