Long-term pulmonary sequelae in children who were treated with extracorporeal membrane oxygenation for neonatal respiratory failure.
OBJECTIVE
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for neonates with intractable respiratory failure, but the long-term pulmonary outcome is unknown. Our aim was to investigate the long-term pulmonary sequelae of these children.


METHODS
We studied 50 children at 11.1 +/- 1.1 years (mean +/- SD) who had been treated with neonatal ECMO for meconium aspiration syndrome (38%), sepsis (18%), sepsis with pneumonia (12%), congenital diaphragmatic hernia (12%), congenital heart disease (8%), persistent pulmonary hypertension of the newborn (6%), and respiratory distress syndrome (4%) and 27 healthy controls (10.8 +/- 1.6 years). All subjects completed a respiratory questionnaire and performed pulmonary function and graded cardiopulmonary exercise testing.


RESULTS
Neonatal ECMO survivors had hyperinflation (median residual volume: 131%), airway obstruction (median forced expired volume in 1 second: 79%), lower oxygen saturation with exercise, and lower peak oxygen consumption than controls. The ECMO group achieved similar exercise minute ventilation to controls, with more rapid and shallow breathing. ECMO survivors had an increased frequency of exercise-induced bronchospasm. Those who required higher inspired oxygen tension and ventilator pressures after weaning from ECMO had lower forced expired volume in 1 second and oxygen saturation values.


CONCLUSIONS
Neonatal ECMO survivors experience lung injury lasting into later childhood. Lung dysfunction correlates with the extent and duration of barotrauma and oxygen exposure as neonates.
Hamutcu
Refika
R
Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA.
Nield
Toni A
TA
Garg
Meena
M
Keens
Thomas G
TG
Platzker
Arnold C G
AC
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology; D001250:Asthma, Exercise-Induced / Q000209:etiology; D001469:Barotrauma / Q000150:complications* / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D005080:Exercise Test; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007231:Infant, Newborn; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D012115:Residual Volume; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*
D010100:Oxygen