Hofkosh D, Thompson A E, Nozza R J, Kemp S S, Bowen A, Feldman H M
Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania.
Pediatrics. 1991 Apr;87(4):549-55.
Cf 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 greater than or equal to 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 less than 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.
在10年期间接受体外膜肺氧合治疗的87名幸存者中，67人参与了一项随访研究，该研究包括神经学检查（n = 67）、认知测试（n = 67）和听力评估（n = 33）。还对5岁以上的匹配对照受试者进行了评估。如果认知分数大于或等于85且神经学检查结果正常，则结果定义为正常；认知分数在70至84之间或有非局灶性神经学表现（如张力亢进/张力减退），则结果可疑；认知分数小于70或神经学检查结果异常，则结果为异常。在研究的10名学龄儿童中，9名正常，受试者和对照之间的平均认知分数没有差异（受试者智商= 109±12[标准差]，对照智商= 107±13）。对于年龄在2.7至4.11岁的学龄前儿童，平均认知分数为91±11，7名（70%）正常。对于6至30个月的婴儿，平均认知分数为101±22，27名（57%）正常。共有7名儿童（占研究对象的21%）听力评估异常。3名儿童表现为轻度高频和4名中度重度高频感音神经性听力损失，其中3名双侧受累，1名侧别未确定。神经发育异常结果与脑梗死和慢性肺病显著相关。结果与人口统计学或围产期变量、体外膜肺氧合治疗前的疾病严重程度或潜在诊断无关。本系列中体外膜肺氧合治疗幸存者的神经发育结果与先前关于传统治疗的严重呼吸衰竭新生儿发病率的报告一致。
