Madderom Marlous J, Schiller Raisa M, Gischler Saskia J, van Heijst Arno F J, Tibboel Dick, Aarsen Femke K, IJsselstijn Hanneke
1Intensive Care Unit, Department of Pediatric Surgery Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands. 2Department of Neonatology Radboud University Medical Center, Nijmegen, The Netherlands.
Crit Care Med. 2016 Jun;44(6):1182-90. doi: 10.1097/CCM.0000000000001626.
To assess neuropsychologic outcome in 17- and 18-year-old neonatal extracorporeal membrane oxygenation survivors.
A prospective longitudinal follow-up study.
Follow-up program at the Erasmus MC-Sophia Children's Hospital in Rotterdam, The Netherlands.
Thirty adolescents 17 or 18 years old, treated between 1991 and 1997, underwent neuropsychologic assessment.
None.
Attention, memory, executive functioning, visual-spatial functions, social-emotional functioning, and behavior were assessed with validated instruments, and data were compared with reference data. Included predictors for analysis of adverse outcome were diagnosis, age at start extracorporeal membrane oxygenation, convulsions, and use of antiepileptics. Adolescents' performance (expressed as mean [SD] z score) was significantly lower than the norm on short-term and long-term verbal memory (z score = -1.40 [1.58], p = 0.016; z score = -1.54 [1.67], p = 0.010, respectively), visual-spatial memory (z score = -1.65 [1.37], p = 0.008; z score = -1.70 [1.23], p = 0.008, respectively), and working memory (32% vs 9% in the norm population). Parents reported more problems for their children regarding organization of materials (z score = -0.60 [0.90]; p = 0.03) and behavior evaluation (z score = -0.53 [0.88]; p = 0.05) on a questionnaire. Patients reported more withdrawn/depressed behavior (z score = -0.47 [0.54]; p = 0.02), somatic complaints (z score = -0.43 [0.48]; p = 0.03), and social problems (z score = -0.41 [0.46]; p = 0.04). Patients reported more positive feelings of self-esteem and an average health status.
Adolescents treated with neonatal extracorporeal membrane oxygenation are at risk of verbal, visual-spatial, and working memory problems. Future research should focus on 1) the longitudinal outcome of specific neuropsychologic skills in adolescence and adulthood; 2) identifying risk factors of neuropsychologic dysfunction; 3) evaluating to what extent "severity of illness" is responsible for acquired brain injury; and 4) effects of timely cognitive rehabilitation.
评估17岁和18岁的新生儿体外膜肺氧合治疗幸存者的神经心理结局。
一项前瞻性纵向随访研究。
荷兰鹿特丹伊拉斯姆斯医学中心索菲亚儿童医院的随访项目。
30名年龄在17或18岁的青少年，于1991年至1997年接受治疗，接受了神经心理评估。
无。
使用经过验证的工具评估注意力、记忆力、执行功能、视觉空间功能、社会情感功能和行为，并将数据与参考数据进行比较。纳入分析不良结局的预测因素包括诊断、开始体外膜肺氧合治疗时的年龄、惊厥和抗癫痫药物的使用。青少年的表现（以平均[标准差]z评分表示）在短期和长期言语记忆方面（z评分分别为-1.40[1.58]，p = 0.016；z评分=-1.54[1.67]，p = 0.010）、视觉空间记忆方面（z评分分别为-1.65[1.37]，p = 0.008；z评分=-1.70[1.23]，p = 0.008）和工作记忆方面（在正常人群中分别为32%和9%）显著低于正常水平。父母在一份问卷中报告，他们的孩子在材料组织（z评分=-0.60[0.90]；p = 0.03）和行为评估（z评分=-0.53[0.88]；p = 0.05）方面存在更多问题。患者报告有更多退缩/抑郁行为（z评分=-0.47[0.54]；p = 0.02）、躯体不适（z评分=-0.43[0.48]；p = 0.03）和社会问题（z评分=-0.41[0.46]；p = 0.04）。患者报告有更多积极的自尊感受和平均健康状况。
接受新生儿体外膜肺氧合治疗的青少年存在言语、视觉空间和工作记忆问题的风险。未来的研究应聚焦于：1）青少年和成年期特定神经心理技能的纵向结局；2）识别神经心理功能障碍的风险因素；3）评估“疾病严重程度”对获得性脑损伤的影响程度；4）及时进行认知康复的效果。
