Schiller Raisa M, Madderom Marlous J, Reuser Jolanda J C M, Steiner Katerina, Gischler Saskia J, Tibboel Dick, van Heijst Arno F J, IJsselstijn Hanneke
Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; and.
Departments of Medical Psychology, and.
Pediatrics. 2016 Nov;138(5). doi: 10.1542/peds.2016-1313. Epub 2016 Oct 6.
To assess the longitudinal development of intelligence and its relation to school performance in a nationwide cohort of neonatal extracorporeal membrane oxygenation (ECMO) survivors and evaluate predictors of outcome at 8 years of age.
Repeated measurements assessed intelligence of neonatal ECMO survivors at 2, 5, and 8 years (n = 178) with the use of validated, standardized instruments. Selective attention (n = 148) and type of education were evaluated in the 8-year-olds.
Intelligence remained stable and average across development (mean ± SD IQ: at 2 years, 102 ± 18; at 5 years, 100 ± 17; and at 8 years, 99 ± 17 [P = .15]). Children attending regular education without the need for help (n = 101; mean z score: -1.50 ± 1.93) performed significantly better on the selective attention task compared with those children who needed extra help (n = 65; mean z score: -2.54 ± 3.18) or those attending special education (n = 13; mean z score: -4.14 ± 3.63) (P = .03). However, only children attending special education had below-average intelligence (mean IQ: 76 ± 15), compared with average intelligence for those attending regular education, both with help (mean IQ: 95 ± 15) and without help (mean IQ: 105 ± 16). Compared with children with other diagnoses, children with congenital diaphragmatic hernia (CDH) scored significantly lower on both IQ (CDH, mean IQ: 93 ± 20; meconium aspiration syndrome, mean IQ: 100 ± 15; other diagnoses, mean IQ: 100 ± 19 [P = .04]) and selective attention (CDH, mean z score: -3.48 ± 3.46; meconium aspiration syndrome, mean z score: -1.60 ± 2.13; other diagnoses, mean z score: -1.65 ± 2.39 [P = .002]).
For the majority of neonatal ECMO survivors, intelligence testing alone did not identify those at risk for academic problems. We propose internationally standardized follow-up protocols that focus on long-term, problem-oriented neuropsychological assessment.
评估全国范围内新生儿体外膜肺氧合（ECMO）幸存者队列的智力纵向发育情况及其与学业成绩的关系，并评估8岁时的预后预测因素。
使用经过验证的标准化工具，对178名新生儿ECMO幸存者在2岁、5岁和8岁时的智力进行重复测量。对8岁儿童评估选择性注意力（n = 148）和教育类型。
在整个发育过程中智力保持稳定且处于平均水平（平均±标准差智商：2岁时为102±18；5岁时为100±17；8岁时为99±17[P = 0.15]）。与那些需要额外帮助的儿童（n = 65；平均z分数：-2.54±3.18）或接受特殊教育的儿童（n = 13；平均z分数：-4.14±3.63）相比，无需帮助接受常规教育的儿童（n = 101；平均z分数：-1.50±1.93）在选择性注意力任务上表现明显更好（P = 0.03）。然而，只有接受特殊教育的儿童智力低于平均水平（平均智商：76±15），相比之下，接受常规教育的儿童，无论是否得到帮助，智力均处于平均水平，得到帮助的平均智商为95±15，未得到帮助的平均智商为105±16。与其他诊断的儿童相比，先天性膈疝（CDH）患儿在智商（CDH，平均智商：93±20；胎粪吸入综合征，平均智商：100±15；其他诊断，平均智商：100±19[P = 0.04]）和选择性注意力（CDH，平均z分数：-3.48±3.46；胎粪吸入综合征，平均z分数：-1.60±2.13；其他诊断，平均z分数：-1.65±2.39[P = 0.002]）方面得分显著更低。
对于大多数新生儿ECMO幸存者，仅通过智力测试无法识别有学业问题风险的儿童。我们建议采用国际标准化的随访方案，重点关注长期、以问题为导向的神经心理学评估。
