Ten Years of Extracorporeal Membrane Oxygenation: Neurodevelopmental Outcome

Abstract

Of the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores ≥85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores <70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 ± 12 [SD], IQ controls = 107 ± 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 ± 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 ± 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

Seizures as a Predictor of Long-Term Neurodevelopmental Outcome in Survivors of Neonatal Extracorporeal Membrane Oxygenation (ECMO)

“…5 A smaller study also showed that 10 neonatal ECMO survivors between the ages of 3 to 4 years had average mean Full-Scale IQs and 70% performed in the normal cognitive range (Full-Scale IQ ≥ 85) on the Stanford-Binet Intelligence Scale. 4 In the present study, the ECMO preschool group had an average Stanford-Binet IQ (mean 90.8) and 66% performed in the normal range (Full-Scale IQ ≥ 85), which is consistent with previous reports. However, when separated into groups according to the presence or absence of seizure activity associated with neonatal ECMO, the mean Stanford-Binet IQ falls to the low-average range for the seizure group and 56% scored ≤ 84.…”

“…Previous descriptive studies have reported the developmental outcomes of neonatal ECMO survivors. [3][4][5] Glass et al compared 102 survivors of ECMO at 5 years of age with 37 healthy control children and found that the ECMO group had an average mean Full-Scale IQ (mean 96 ± 20). 5 A smaller study also showed that 10 neonatal ECMO survivors between the ages of 3 to 4 years had average mean Full-Scale IQs and 70% performed in the normal cognitive range (Full-Scale IQ ≥ 85) on the Stanford-Binet Intelligence Scale.…”

Congenital abnormalities.

“…Studies have generally shown that the growth and intellectual functioning until age 3 years of children without CHD treated with ECMO during the neonatal period are equal to or just below age-expected levels (Andrews, Nixon, Cilley, Roloff, & Bartlett, 1986;Taylor, Glass, Fitz, & Miller, 1987). Longer term follow-up studies into middle childhood have also indicated that most children grow and develop normally, but neurological complications occur in almost 20% of cases (Hofkosh et al, 1991). However, little is known about children who have received ECMO after cardiac surgery.…”