Nield T A, Langenbacher D, Poulsen M K, Platzker A C
Divisions of Neonatology, Pediatric Pulmonology, and University Affiliated Program-Center for Child Development, Childrens Hospital of Los Angeles, University of Southern California School of Medicine, Los Angeles, CA 90027, USA.
J Pediatr. 2000 Mar;136(3):338-44. doi: 10.1067/mpd.2000.103359.
Recent studies suggest that for neonates treated with extracorporeal membrane oxygenation (ECMO), children with congenital diaphragmatic hernia (CDH) have poorer neurodevelopmental outcome than children with other diagnoses. We therefore analyzed the neurodevelopmental outcome at 3(1/2) years of age in 130 neonatal ECMO survivors with 6 different primary diagnoses.
Children were assessed with the McCarthy Scales of Children's Abilities, Peabody Picture Vocabulary Test, Vineland Adaptive Behavior Scales, and a neurologic/physical examination; 12 factors related to infant characteristics and ECMO/hospital course including primary diagnosis were identified as independent variables. Dependent variables included test scores and 2 outcome categories: functional status (normal, risk, abnormal) and major neurologic sequelae (presence or absence). Statistical tools included chi-squared analysis, t test, analysis of variance, and discriminant and regression analysis.
No significant differences were found between diagnostic groups in functional status or neurologic sequelae. Hospital days was the only variable consistently expressed in all analyses as having significant influence on the outcome measures. This was not a factor of the longer hospital days experienced by children with CDH.
Neurodevelopmental outcome in neonatal ECMO is multifactorial. Although hospital days has the greatest association with outcome at age 3(1/2) years, these days likely reflect degree of illness and various complications that are independent of diagnostic group. Further study is required to determine which factors influencing the length of hospital stay may be the best predictor of long-term outcome.
近期研究表明，对于接受体外膜肺氧合（ECMO）治疗的新生儿，先天性膈疝（CDH）患儿的神经发育结局比其他诊断的患儿更差。因此，我们分析了130名患有6种不同原发性诊断的新生儿ECMO幸存者在3.5岁时的神经发育结局。
使用麦卡锡儿童能力量表、皮博迪图片词汇测验、文兰适应行为量表以及神经/体格检查对儿童进行评估；确定了12个与婴儿特征以及ECMO/住院过程相关的因素（包括原发性诊断）作为自变量。因变量包括测试分数以及2个结局类别：功能状态（正常、有风险、异常）和主要神经后遗症（存在或不存在）。统计工具包括卡方分析、t检验、方差分析以及判别分析和回归分析。
各诊断组在功能状态或神经后遗症方面未发现显著差异。住院天数是在所有分析中始终显示对结局指标有显著影响的唯一变量。这并非是CDH患儿住院时间较长的一个因素。
新生儿ECMO的神经发育结局是多因素的。尽管住院天数与3.5岁时的结局关联最大，但这些天数可能反映的是疾病严重程度和各种并发症，而与诊断组无关。需要进一步研究以确定哪些影响住院时间的因素可能是长期结局的最佳预测指标。
