Vaucher Y E, Dudell G G, Bejar R, Gist K
Department of Pediatrics, University of California, San Diego School of Medicine 92103-8774, USA.
J Pediatr. 1996 Jan;128(1):109-17. doi: 10.1016/s0022-3476(96)70439-0.
To examine the effect of neonatal risk factors and treatment strategy on pulmonary, growth, and neurodevelopmental outcome of candidates for extracorporeal membrane oxygenation (ECMO).
We prospectively assessed growth and neurodevelopmental outcome in a cohort of 190 neonates who had severe respiratory failure, no major congenital anomalies, and met institutional criteria for the use of ECMO. The relationships among perinatal risk factors, neonatal outcome, postnatal growth, and neurodevelopmental outcome were studied by univariate and multivariate analyses.
Compared with 52 infants successfully treated with conventional or high-frequency ventilation, the 138 ECMO survivors were more mature, had earlier, more severe pulmonary disease, and were more likely to have meconium aspiration. The ECMO survivors had significantly fewer ventilator days (9 vs 11), hospital days (23 vs 29), and less (12% vs 25%) chronic lung disease (CLD). At 12 to 30 months, mean developmental scores of ECMO survivors were similar to those of infants who survived without ECMO. Infants with CLD had significantly lower motor scores (86 +/- 23 vs 100 +/- 19) and were more likely to have cerebral palsy (27% vs 6%) than those without CLD. The risk of adverse neurodevelopmental outcome was independently increased by CLD (odds ratio, 2.4; confidence interval, 1.2 to 4.6) and moderate or severe neonatal neuroimaging abnormalities (odds ratio, 6.4; confidence interval, 1.9 to 21.9).
Neonatal ECMO candidates treated with ECMO did as well or better than neonates whose conditions were managed with alternate treatment strategies. Adverse neurodevelopmental outcome was predicted by moderate or severe neonatal neuroimaging abnormalities and CLD, not by treatment with ECMO.
探讨新生儿危险因素及治疗策略对体外膜肺氧合（ECMO）治疗候选患儿肺部、生长及神经发育结局的影响。
我们前瞻性评估了190例患有严重呼吸衰竭、无重大先天性畸形且符合机构ECMO使用标准的新生儿队列的生长及神经发育结局。通过单因素和多因素分析研究围产期危险因素、新生儿结局、出生后生长及神经发育结局之间的关系。
与52例成功接受传统或高频通气治疗的婴儿相比，138例ECMO存活者更成熟，肺部疾病出现更早、更严重，且更易发生胎粪吸入。ECMO存活者的机械通气天数（9天对11天）、住院天数（23天对29天）显著减少，慢性肺病（CLD）发生率更低（12%对25%）。在12至30个月时，ECMO存活者的平均发育评分与未接受ECMO治疗而存活的婴儿相似。与无CLD的婴儿相比，患有CLD的婴儿运动评分显著更低（86±23对100±19），且更易患脑瘫（27%对6%）。CLD（比值比，2.4；置信区间，1.2至4.6）及中度或重度新生儿神经影像学异常（比值比，6.4；置信区间，1.9至21.9）独立增加不良神经发育结局的风险。
接受ECMO治疗的新生儿ECMO候选者的情况与采用其他治疗策略管理的新生儿相同或更好。中度或重度新生儿神经影像学异常及CLD可预测不良神经发育结局，而非ECMO治疗。
