Neurodevelopmental outcome at 3.5 years of age in children treated with extracorporeal life support: relationship to primary diagnosis.

Abstract

Recent studies suggest that for neonates treated with extracorporeal membrane oxygenation (ECMO), children with congenital diaphragmatic hernia (CDH) have poorer neurodevelopmental outcome than children with other diagnoses. We therefore analyzed the neurodevelopmental outcome at 3(1/2) years of age in 130 neonatal ECMO survivors with 6 different primary diagnoses. Children were assessed with the McCarthy Scales of Children's Abilities, Peabody Picture Vocabulary Test, Vineland Adaptive Behavior Scales, and a neurologic/physical examination; 12 factors related to infant characteristics and ECMO/hospital course including primary diagnosis were identified as independent variables. Dependent variables included test scores and 2 outcome categories: functional status (normal, risk, abnormal) and major neurologic sequelae (presence or absence). Statistical tools included chi-squared analysis, t test, analysis of variance, and discriminant and regression analysis. No significant differences were found between diagnostic groups in functional status or neurologic sequelae. Hospital days was the only variable consistently expressed in all analyses as having significant influence on the outcome measures. This was not a factor of the longer hospital days experienced by children with CDH. Neurodevelopmental outcome in neonatal ECMO is multifactorial. Although hospital days has the greatest association with outcome at age 3(1/2) years, these days likely reflect degree of illness and various complications that are independent of diagnostic group. Further study is required to determine which factors influencing the length of hospital stay may be the best predictor of long-term outcome.