Pulmonary sequelae in infants treated with extracorporeal membrane oxygenation

Greenspan, Jay S.; Antunes, Michael; Holt, William J.; McElwee, Dorothy; Cullen, James A.; Spitzer, Alan R.

doi:10.1002/(sici)1099-0496(199701)23:1<31::aid-ppul4>3.0.co;2-s

Cited by 13 publications

(3 citation statements)

References 19 publications

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“…Greenspan et al . [ 9 ] suggested that delaying ECMO therapy might increase the risk of lung injury, particularly to the airway. New treatment strategies and ventilator techniques for respiratory failure were introduced in the past decade with the implication of fewer requirements for ECMO.…”

Section: Discussionmentioning

confidence: 99%

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et al. 2005

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et al. 2005

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“…This delay may worsen acute lung injury due to continued exposure to high ventilator settings and high FiO 2 instead of the "lung rest" achieved with ECMO. 13 Therefore, to determine whether iNO treatment of newborns with severe PPHN results in chronic changes in lung function during infancy, we prospectively studied pulmonary function of infants following treatment of PPHN with iNO. We measured lung volumes and passive respiratory mechanics in infants who had severe PPHN and had been treated with either conventional therapy or with iNO, and compared these values to those of healthy controls and to infants with known interstitial lung disease.…”

Section: Introductionmentioning

confidence: 99%

Infant lung function after inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn

et al. 1999

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Summary. Our objectives were to determine whether the use of inhaled nitric oxide (iNO) for severe persistent pulmonary hypertension of the newborn (PPHN) causes impaired lung function during infancy. We therefore performed a prospective study of lung function in 22 infants after neonatal intensive care unit (NICU) discharge who had been treated for severe persistent pulmonary hypertension of the newborn (PPHN) with (n = 15) or without (n = 7) iNO, and compared these findings in lung function to those of healthy control infants (n = 18). Five infants with interstitial lung disease (ILD) were included to assure that the pulmonary function tests (PFT) were sensitive enough to detect abnormalities of lung function in this age group. We measured passive respiratory mechanics and functional residual capacity (FRC) using a commercially available system. All data were expressed as means and standard deviation. Statistical analysis was performed by analysis of variance (ANOVA). A Bonferroni multiple comparisons test was used for variables that showed overall group differences.Twenty-two infants were studied during follow-up 4-12 months after NICU discharge. None of the infants were acutely ill, and only one infant was on 0.25 L of oxygen per minute at the time of study. We found no differences in lung function between the treatment groups (iNO + mechanical ventilation (MV), or MV alone), or between either treatment group and healthy control infants of the same age. We were able to detect significant differences in functional residual capacity adjusted for weight or height, and compliance of the respiratory system adjusted for weight or lung volume in the ILD infants compared to the healthy controls or infants who had PPHN, indicating that these PFTs were sensitive enough to determine abnormal lung function in this age group.We conclude that inhaled nitric oxide therapy for the treatment of severe PPHN does not alter lung function as determined by lung volume and passive respiratory mechanics measurements during early infancy. Pediatr Pulmonol. 1999; 28:24-30.

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“…The long-term pulmonary sequelae of neonatal ECMO have hardly been studied. Crosssectional studies during or shortly after ECMO all reported reduced lung function, perhaps due to severity of the underlying respiratory disease [6][7][8][9][10].…”

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Diagnosis-related deterioration of lung function after extracorporeal membrane oxygenation

et al. 2012

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The aim of the study was to assess lung function longitudinally after neonatal extracorporeal membrane oxygenation (ECMO), and to identify any effects of diagnosis and perinatal characteristics.121 neonatal ECMO-treated children (70 with meconium aspiration syndrome, 20 congenital diaphragmatic hernia and 31 with other diagnoses) performed a total of 191 lung function measurements at 5, 8 and/or 12 yrs. We assessed dynamic and static lung volumes, reversibility of airway obstruction and diffusion capacity.Mean SDS forced expiratory volume in 1 s (FEV1) at 5 yrs before and after bronchodilation (-0.51 and 0.07) was significantly higher than at 8 (-0.79 and -0.4; p,0.04) and 12 yrs (-1.10 and -0.52; p,0.003). Mean SDS for all spirometric parameters before and after bronchodilation were significantly lower in the congenital diaphragmatic hernia group compared with the other diagnostic groups (all pf0.025). A significant volume of trapped air was observed in 86% patients with congenital diaphragmatic hernia, 50% with meconium aspiration syndrome and 58% with other diagnoses. After bronchodilation, mean SDS FEV1 and forced vital capacity were negatively influenced by duration of ventilation (both p,0.001) and duration of ECMO (p50.003 and p50.02, respectively).Long-term pulmonary sequelae after neonatal ECMO-treatment mainly occur in congenital diaphragmatic hernia patients and tend to deteriorate over time.

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Pulmonary sequelae in infants treated with extracorporeal membrane oxygenation

Cited by 13 publications

References 19 publications

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Infant lung function after inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn

Diagnosis-related deterioration of lung function after extracorporeal membrane oxygenation

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