Toni A. Nield

Long-term pulmonary sequelae in children who were treated with extracorporeal membrane oxygenation for neonatal respiratory failure.

Objective. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for neonates with intractable respiratory failure, but the long-term pulmonary outcome is unknown. Our aim was to investigate the long-term pulmonary sequelae of these children. Study Design. We studied 50 children at 11.1 ± 1.1 years (mean ± SD) who had been treated with neonatal ECMO for meconium aspiration syndrome (38%), sepsis (18%), sepsis with pneumonia (12%), congenital diaphragmatic hernia (12%), congenital heart disease (8%), persistent pulmonary hypertension of the newborn (6%), and respiratory distress syndrome (4%) and 27 healthy controls (10.8 ± 1.6 years). All subjects completed a respiratory questionnaire and performed pulmonary function and graded cardiopulmonary exercise testing. Results. Neonatal ECMO survivors had hyperinflation (median residual volume: 131%), airway obstruction (median forced expired volume in 1 second: 79%), lower oxygen saturation with exercise, and lower peak oxygen consumption than controls. The ECMO group achieved similar exercise minute ventilation to controls, with more rapid and shallow breathing. ECMO survivors had an increased frequency of exercise-induced bronchospasm. Those who required higher inspired oxygen tension and ventilator pressures after weaning from ECMO had lower forced expired volume in 1 second and oxygen saturation values. Conclusion. Neonatal ECMO survivors experience lung injury lasting into later childhood. Lung dysfunction correlates with the extent and duration of barotrauma and oxygen exposure as neonates.

NEURODEVELOPMENTAL OUTCOME AT 3.5 YEARS OF AGE IN ECMO TREATED CHILDREN: RELATIONSHIP TO PRIMARY DIAGNOSIS † 1224

NEURODEVELOPMENTAL OUTCOME AT 3.5 YEARS OF AGE IN ECMO TREATED CHILDREN: RELATIONSHIP TO PRIMARY DIAGNOSIS † 1224

NEURODEVELOPMENTAL OUTCOME AND POTENTIAL FOR ACADEMIC DIFFICULTIES IN ECMO SURVIVORS AT FIVE YEARS OF AGE † 1192

Introduction. Neurodevelopmental outcome studies of school age children who required extracorporeal membrane oxygenation (ECMO) as a newborn due to severe cardiorespiratory failure suggest that these children are at greater risk for learning disabilities and mental retardation than in the general population. In an attempt to further clarify the nature of potential learning disabilities of children who received ECMO, we assessed the neurodevelopmental status of our ECMO survivors at five years of age.

CRANIAL CT AND NEURODEVELOPMENTAL OUTCOME IN ECMO NEONATES EXPERIENCING AN ARREST. 1626

Little is known on the long term neurodevelopmental impact of a cardiopulmonary arrest on neonates with intractable cardiorespiratory failure who are being treated with ECMO. We previously reported on survival and neurodevelopmental outcome in a cohort of ECMO treated neonates matched by diagnosis for arrest (AG) and non-arrest (NAG) status. The current study was undertaken to correlate the cranial CT scans with the neurodevelopmental outcome in the survivors of this cohort. CT scans were performed on the AG at a median of 15 days of age, and on the NAG at a median of 12 days of age. In the AG, CT scans were done at a median of 13 days post arrest. The timing of arrests included 27 prior to ECMO (including 11 at cannulation, and 3 infants with multiple arrests) and 2 post ECMO. At follow up, age 12 to 42 months, the discharge CT scans of 29/30 AG (32±12 months, Mean±SD) and 31/35 NAG (33±11 months) children were reviewed by a neuroradiologist who was blinded to patient arrest and outcome status. Major findings on CT included:*p=0.049 In the AG with CT findings of low perfusion injury (i.e. vascular border zone necrosis), all arrests occurred at cannulation. The one NAG infant with a low perfusion injury had profound intrapartum asphyxia and fetal bradycardia. On neurodevelopmental follow up, 3 infants were abnormal and 1 was suspect. In infants with CT findings of an infarct (i.e. necrosis in a vascular distribution), neurodevelopmental outcome included 1 child whose exam was normal, 2 suspect, and 4 abnormal. In conclusion, neonates meeting the criteria for ECMO, but who have also had an arrest are not at an increased risk for low perfusion injury to the brain over their non-arrest cohorts. The increased incidence of intracranial infarcts in this group deserves continued neurodevelopmental study. All infants with major findings on CT following treatment with ECMO are at very high risk for significant neurodevelopmental problems and require close long term follow up.Table