Outcome of extracorporeal membrane oxygenation survivors at age two years: relationship to status at one year.

The objective of this study was to assess the respiratory, neurologic, and developmental status at age 2 years of children treated with extracorporeal membrane oxygenation (ECMO) as neonates. The study population comprised patients treated at a tertiary care neonatal unit and included in a high-risk follow-up program. Eighty-five consecutive patients were treated with ECMO between June 1987 and October 1990, of which 64 (75%) survived. Forty-eight (73%) of the survivors underwent evaluation of growth and respiratory status, neurologic examination, and psychometric testing at ages 1 and 2 years. At age 2 years, 21% of study patients had at least one abnormal growth parameter (weight or length < 5%, head circumference < 2%). Twenty-one percent required respiratory medications and two children had tracheostomies. Six percent had significant abnormalities on neurologic examination. Twenty-five percent scored between 70 and 85 on the mental or psychomotor scales (or both) of the Bayley Scales of Infant Development or the Stanford-Binet, and 12% scored less than 70. Seventy-three percent of children who scored 70 to 85 on one or both subscales of the Bayley Scales of Infant Development or the Stanford-Binet at 2 years had normal scores at 1 year, as did 50% with scores less than 70. Spearman rank analysis suggested a relationship between congenital diaphragmatic hernia, neonatal electroencephalogram, and computed tomography of the head and developmental status at age 2 years (p < 0.05). We conclude that children treated with ECMO are at significant risk for abnormalities in growth and neurodevelopmental and respiratory status at age 2 years, which may not be evident at earlier assessments. This highlights the need for continued follow-up.