Robertson C M, Finer N N, Sauve R S, Whitfield M F, Belgaumkar T K, Synnes A R, Grace M G
Department of Pediatrics, University of Alberta, Edmonton.
CMAJ. 1995 Jun 15;152(12):1981-8.
To determine the neurodevelopmental outcome of neonates who underwent extracorporeal membrane oxygenation (ECMO group) and similarly critically ill newborns with a lower Oxygenation Index who underwent conventional treatment (comparison group), and to determine whether factors such as the underlying diagnosis and the distance transported from outlying areas affect outcome.
Multicentre prospective longitudinal comparative outcome study.
An ECMO centre providing services to all of western Canada and four tertiary care neonatal follow-up clinics.
All neonates who received treatment between February 1989 and January 1992 at the Western Canadian Regional ECMO Center and who were alive at 2 years of age; 38 (95%) of the 40 surviving ECMO-treated subjects and 26 (87%) of the 30 surviving comparison subjects were available for follow-up.
ECMO or conventional therapy for respiratory failure.
Neurodevelopmental disability (one or more of cerebral palsy, visual or hearing loss, seizures, severe cognitive disability), and mental and performance developmental indexes of the Bayley Scales of Infant Development.
Six (16%) of the ECMO-treated children had neurodevelopmental disabilities at 2 years of age, as compared with 1 (4%) of the comparison subjects; the difference was not statistically significant. The mean mental developmental index (91.8 [standard deviation (SD) 19.5] v. 100.5 [SD 25.4]) and the mean performance developmental index (87.2 [SD 20.0] v. 96.4 [SD 20.9]) did not differ significantly between the ECMO group and the comparison group respectively. Among the ECMO-treated subjects those whose underlying diagnosis was sepsis had the lowest Bayley indexes, significantly lower than those whose underlying diagnosis was meconium aspiration syndrome. The distance transported did not affect outcome.
Neurodevelopmental disability and delay occurred in both groups. The underlying diagnosis appears to affect outcome, whereas distance transported does not. These findings support early transfer for ECMO of critically ill neonates with respiratory failure who do not respond to conventional treatment. Larger multicentre studies involving long-term follow-up are needed to confirm these findings.
确定接受体外膜肺氧合治疗的新生儿（体外膜肺氧合组）以及接受常规治疗、氧合指数较低的病情同样危重的新生儿（对照组）的神经发育结局，并确定诸如潜在诊断和从偏远地区转运的距离等因素是否会影响结局。
多中心前瞻性纵向比较结局研究。
一个为加拿大西部所有地区提供服务的体外膜肺氧合中心以及四家三级护理新生儿随访诊所。
1989年2月至1992年1月期间在加拿大西部区域体外膜肺氧合中心接受治疗且2岁时仍存活的所有新生儿；40名接受体外膜肺氧合治疗的存活受试者中有38名（95%）、30名存活的对照受试者中有26名（87%）可供随访。
针对呼吸衰竭进行体外膜肺氧合或常规治疗。
神经发育残疾（脑瘫、视力或听力丧失、癫痫、严重认知残疾中的一项或多项）以及贝利婴儿发育量表的智力和运动发育指数。
接受体外膜肺氧合治疗的儿童中有6名（16%）在2岁时存在神经发育残疾，而对照组中有1名（4%）；差异无统计学意义。体外膜肺氧合组和对照组的平均智力发育指数分别为91.8（标准差[SD]19.5）和100.5（SD 25.4），平均运动发育指数分别为87.2（SD 20.0）和96.4（SD 20.9），差异均无统计学意义。在接受体外膜肺氧合治疗的受试者中，潜在诊断为败血症的患儿贝利指数最低，显著低于潜在诊断为胎粪吸入综合征的患儿。转运距离并未影响结局。
两组均出现神经发育残疾和发育延迟。潜在诊断似乎会影响结局，而转运距离则不会。这些发现支持对常规治疗无反应的呼吸衰竭危重新生儿尽早转运至体外膜肺氧合中心。需要开展涉及长期随访的更大规模多中心研究来证实这些发现。
