From the Department of Pediatrics, University of Texas Southwestern Medical Center.
Critical Care Services, Children's Health.
ASAIO J. 2020 Apr;66(4):447-453. doi: 10.1097/MAT.0000000000001035.
In this pilot study, we evaluated the long-term neurodevelopmental outcomes in neonatal and pediatric patients supported by extracorporeal membrane oxygenation (ECMO) and aimed to identify the role of post-ECMO magnetic resonance imaging (MRI) in predicting neurodevelopmental outcomes. Twenty-nine patients were evaluated using the Ages and Stages Questionnaire, Third Edition (ASQ-3) screening tool. Thirteen were evaluated during their visit at the neurodevelopmental clinic and 16 were interviewed via phone. We also reviewed the post-ECMO MRI brain of these patients and scored the severity of their injury based on the neuroimaging findings. In our cohort of 29 patients, 10 patients (34%) had developmental delay. Of those with developmental delay, 80% were newborns. Sixty-seven percent of patients with developmental delay had moderate to severe MRI abnormalities as compared with only 18% with no developmental deficits (p = 0.03). The younger the age at the time of placement on ECMO, the higher the chances of impaired neurodevelopmental outcome. Long-term follow-up of patients who have survived ECMO, with standardized neuropsychologic testing and post-ECMO imaging, should become the standard of care to improve long-term outcomes. Significant abnormalities on brain MRIs done before discharge correlated with developmental delay on follow-up.
在这项初步研究中，我们评估了接受体外膜氧合（ECMO）支持的新生儿和儿科患者的长期神经发育结局，并旨在确定 ECMO 后磁共振成像（MRI）在预测神经发育结局方面的作用。使用《年龄与阶段问卷》第三版（ASQ-3）筛查工具评估了 29 名患者。其中 13 名在神经发育诊所就诊时进行评估，16 名通过电话进行评估。我们还回顾了这些患者的 ECMO 后脑部 MRI，并根据神经影像学发现对其损伤严重程度进行评分。在我们的 29 名患者队列中，有 10 名患者（34%）存在发育迟缓。在发育迟缓的患者中，80%为新生儿。与无发育缺陷的患者（18%）相比，有发育迟缓的患者中有 67%的 MRI 异常程度为中度至重度，而只有 18%（p=0.03）。在 ECMO 上的年龄越小，神经发育结局受损的可能性就越高。对接受 ECMO 治疗的患者进行长期随访，包括标准化的神经心理学测试和 ECMO 后影像学检查，应成为改善长期结局的标准治疗方法。出院前进行的脑部 MRI 显示出明显异常与随访时的发育迟缓相关。
