Van Meurs K P, Robbins S T, Reed V L, Karr S S, Wagner A E, Glass P, Anderson K D, Short B L
Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford University Medical Center, California.
J Pediatr. 1993 Jun;122(6):893-9. doi: 10.1016/s0022-3476(09)90013-0.
As more infants with congenital diaphragmatic hernia (CDH) survive with extracorporeal membrane oxygenation (ECMO), it seems prudent to detail the longterm outcome in these medically complex infants. Eighteen children with CDH-treated with postoperative ECMO were recruited for participation in this study. The mean duration of ECMO was 193 hours (range 82 to 493 hours), mean time to extubation after ECMO was 142 hours (range 34 to 312 hours), and median duration of hospitalization was 46 days (range 30 to 181 days). Of the 18 infants, 4 (22%) were discharged home requiring oxygen therapy. At follow-up the notable findings were a high incidence of gastroesophageal reflux and failure to thrive. At both 1 and 2 years of age, 50% of infants were at less than the 5th percentile for weight. At 1 and 2 years of age, 39% and 21%, respectively, were at less than the 5th percentile for weight/length ratio. A total of 16 children (89%) had clinical evidence of reflux, and 8 (44%) were discharged home on a regimen of nasogastric feedings. Reherniation occurred in 4 children (22%) and was more frequent when a patch was used. An electrocardiogram showed right ventricular hypertrophy in 6 (43%); oxygen saturation by pulse oximetry was > 95% in all children, and pulmonary artery pressure was estimated by Doppler echocardiography to be normal in 12 of 14 children examined. The neurodevelopmental outcome (Bayley Scales or Stanford-Binet scale) at 1 to 4 years of age was not dissimilar from that of other ECMO-treated children. Given the severity of illness in the neonatal period, the general health and development of children with CDH surviving after ECMO are good. Surprisingly few children have long-term respiratory complications related to pulmonary hypoplasia. Follow-up in the first few years should be aimed at aggressive nutritional intervention to prevent the growth failure that appears to be prevalent in these children.
随着越来越多患有先天性膈疝（CDH）的婴儿通过体外膜肺氧合（ECMO）存活下来，详细了解这些病情复杂的婴儿的长期预后显得很有必要。本研究招募了18名接受术后ECMO治疗的CDH患儿。ECMO的平均持续时间为193小时（范围82至493小时），ECMO后拔管的平均时间为142小时（范围34至312小时），住院时间中位数为46天（范围30至181天）。18名婴儿中，4名（22%）出院时需要吸氧治疗。随访时的显著发现是胃食管反流发生率高和发育不良。在1岁和2岁时，50%的婴儿体重低于第5百分位。在1岁和2岁时，体重/身长比低于第5百分位的分别为39%和21%。共有16名儿童（89%）有反流的临床证据，8名（44%）出院时采用鼻饲喂养方案。4名儿童（22%）发生复发性疝，使用补片时更常见。心电图显示6名（43%）有右心室肥厚；所有儿童经脉搏血氧饱和度测定的氧饱和度>95%，14名接受检查的儿童中12名经多普勒超声心动图估计肺动脉压力正常。1至4岁时的神经发育结局（贝利量表或斯坦福-比奈量表）与其他接受ECMO治疗的儿童无异。鉴于新生儿期疾病的严重程度，ECMO治疗后存活的CDH患儿的总体健康和发育情况良好。令人惊讶的是，很少有儿童出现与肺发育不全相关的长期呼吸并发症。最初几年的随访应旨在积极进行营养干预，以预防这些儿童中似乎普遍存在的生长发育迟缓。
