Schiller Raisa M, IJsselstijn Hanneke, Madderom Marlous J, Rietman André B, Smits Marion, van Heijst Arno F J, Tibboel Dick, White Tonya, Muetzel Ryan L
1Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 2Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 3Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 4Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Crit Care Med. 2017 Oct;45(10):1742-1750. doi: 10.1097/CCM.0000000000002553.
Survivors of critical illness in early life are at risk of long-term-memory and attention impairments. However, their neurobiologic substrates remain largely unknown.
A prospective follow-up study.
Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Thirty-eight school-age (8-12 yr) survivors of neonatal extracorporeal membrane oxygenation and/or congenital diaphragmatic hernia with an intelligence quotient greater than or equal to 80 and a below average score (z score ≤ -1.5) on one or more memory tests.
None.
Intelligence, attention, memory, executive functioning, and visuospatial processing were assessed and compared with reference data. White matter microstructure and hippocampal volume were assessed using diffusion tensor imaging and structural MRI, respectively. Global fractional anisotropy was positively associated with selective attention (β = 0.53; p = 0.030) and sustained attention (β = 0.48; p = 0.018). Mean diffusivity in the left parahippocampal region of the cingulum was negatively associated with visuospatial memory, both immediate (β = -0.48; p = 0.030) and delayed recall (β = -0.47; p = 0.030). Mean diffusivity in the parahippocampal region of the cingulum was negatively associated with verbal memory delayed recall (left: β = -0.52, p = 0.021; right: β = -0.52, p = 0.021). Hippocampal volume was positively associated with verbal memory delayed recall (left: β = 0.44, p = 0.037; right: β = 0.67, p = 0.012). Extracorporeal membrane oxygenation treatment or extracorporeal membrane oxygenation type did not influence the structure-function relationships.
Our findings indicate specific neurobiologic correlates of attention and memory deficits in school-age survivors of neonatal extracorporeal membrane oxygenation and congenital diaphragmatic hernia. A better understanding of the neurobiology following critical illness, both in early and in adult life, may lead to earlier identification of patients at risk for impaired neuropsychological outcome with the use of neurobiologic markers.
儿童期危重症幸存者存在长期记忆和注意力受损的风险。然而，其神经生物学基础在很大程度上仍不明确。
一项前瞻性随访研究。
荷兰鹿特丹伊拉斯姆斯医学中心索菲亚儿童医院。
38名学龄期（8 - 12岁）新生儿体外膜肺氧合和/或先天性膈疝幸存者，其智商大于或等于80，且在一项或多项记忆测试中得分低于平均水平（z分数≤ -1.5）。
无。
评估智力、注意力、记忆、执行功能和视觉空间处理能力，并与参考数据进行比较。分别使用扩散张量成像和结构磁共振成像评估白质微观结构和海马体积。整体分数各向异性与选择性注意力（β = 0.53；p = 0.030）和持续性注意力（β = 0.48；p = 0.018）呈正相关。扣带回左海马旁区域的平均扩散率与视觉空间记忆的即时回忆（β = -0.48；p = 0.030）和延迟回忆（β = -0.47；p = 0.030）均呈负相关。扣带回海马旁区域的平均扩散率与言语记忆延迟回忆呈负相关（左侧：β = -0.52，p = 0.021；右侧：β = -0.52，p = 0.021）。海马体积与言语记忆延迟回忆呈正相关（左侧：β = 0.44，p = 0.037；右侧：β = 0.67，p = 0.012）。体外膜肺氧合治疗或体外膜肺氧合类型不影响结构 - 功能关系。
我们的研究结果表明，新生儿体外膜肺氧合和先天性膈疝学龄期幸存者注意力和记忆缺陷存在特定的神经生物学关联。更好地理解危重症后早期和成年期的神经生物学，可能有助于利用神经生物学标志物更早地识别有神经心理结局受损风险的患者。
