McNally Helena, Bennett Charlotte C, Elbourne Diana, Field David J
Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
Pediatrics. 2006 May;117(5):e845-54. doi: 10.1542/peds.2005-1167. Epub 2006 Apr 24.
The UK Collaborative ECMO trial provided an opportunity to describe mortality and morbidity associated with a neonatal ECMO policy compared with conventional management. The improved survival in the ECMO group was not offset by an increase in disability at 4 years, but the children were too young to assess educational and other longer-term impacts. The objective of this study was to assess the longer-term impact of these policies at age 7 years.
A psychologist assessed 90 of the 100 children available for follow-up without prior knowledge of treatment allocation. The assessments took place at the children's schools within 3 months of their 7th birthdays.
Sixty-eight of 89 (76%) children recorded a cognitive level within the normal range. Learning problems were similar in the 2 groups, and there were notable difficulties with spatial and processing tasks. A higher respiratory morbidity and increased risk of behavioral problems among children treated conventionally persisted. Progressive sensorineural hearing loss was found in both groups.
The underlying disease processes appear to be the major influence on morbidity at 7 years. The beneficial influence of an ECMO policy is still present at 7 years.
英国体外膜肺氧合协作试验提供了一个机会，来描述与新生儿体外膜肺氧合治疗策略相比，传统治疗的死亡率和发病率情况。体外膜肺氧合治疗组生存率的提高并未被4岁时残疾率的增加所抵消，但这些儿童年龄太小，无法评估教育及其他长期影响。本研究的目的是评估这些治疗策略在儿童7岁时的长期影响。
一名心理学家在对治疗分配不知情的情况下，对100名可供随访的儿童中的90名进行了评估。评估在儿童7岁生日后的3个月内在其学校进行。
89名儿童中有68名（76%）认知水平处于正常范围。两组的学习问题相似，在空间和处理任务方面存在显著困难。接受传统治疗的儿童中，较高的呼吸系统发病率和行为问题风险仍然存在。两组均发现有进行性感觉神经性听力损失情况。
潜在疾病过程似乎是7岁时发病的主要影响因素。体外膜肺氧合治疗策略的有益影响在7岁时仍然存在。
