Neurodevelopmental outcomes in neonatal extracorporeal membrane oxygenation survivors: An institutional perspective

Abstract

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.

Implementing neurodevelopmental follow‐up care for children with congenital heart disease: A scoping review with evidence mapping

“…An additional three publications were identified for full‐text review by subject matter experts and one from forward citation searching of conference abstracts. Full‐text screening of these 193 publications resulted in 35 publications being included in this review 9,13–16,27–56 . The stages of the search and screening process and reasons for exclusion are presented in the PRISMA‐ScR flow diagram (Figure S1).…”

“…More than 20 different types of provider were reported as taking part in included programmes with psychologists/paediatric psychologists ( n = 12), nurses/nurse practitioners ( n = 11), physical therapists ( n = 8), cardiologists ( n = 7), speech therapists ( n = 6), and occupational therapists ( n = 6) the most frequently reported clinicians involved in care. Ten programmes described using a database or registry to track patients and their outcomes 31,33,34,36,38,42,44,47,50,53 …”

“…Full‐text screening of these 193 publications resulted in 35 publications being included in this review. 9 , 13 , 14 , 15 , 16 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 The stages of the search and screening process and reasons for exclusion are presented in the PRISMA‐ScR flow diagram (Figure S1 ).…”

“…The 35 publications included in the scoping review comprised 33 different studies. Of these, 21 studies examined the implementation of specific programmes or care pathways for neurodevelopmental follow-up care, [27][28][29][31][32][33][34][35][36][38][39][40]42,44,[47][48][49][50][51][52][53][54]56 and 12 studies reported on surveys or overviews of current clinical practices in neurodevelopmental follow-up. 9,[13][14][15][16]30,37,41,43,45,46,55 Implementation and evaluation of follow-up programmes or care pathways All studies were published after 2011, with most (15 out of 21) conducted since 2018.…”

“…Ten programmes described using a database or registry to track patients and their outcomes. 31,33,34,36,38,42,44,47,50,53 Accessing follow-up care. Eligibility criteria for programmes varied widely but most included children undergoing early interventions or surgery for CHD and/or who were classified at high risk of developmental disorder according to the AHA.…”