Neurologic outcome in children after extracorporeal membrane oxygenation: prognostic value of diagnostic tests.
This report presents the long-term (36 months) neurologic outcome in 12 neonates and 9 children who survived after extracorporeal membrane oxygenation and attempts to identify its prognostic indicators through a prospective study in the pediatric intensive care unit of a university hospital. Outcome assessment, neurodevelopmental tests, electroencephalogram, auditory evoked potentials, visual evoked potentials, and somatosensory evoked potentials, cerebral sonography, or cerebral tomography were evaluated at the end of bypass and at 6, 12, 24, and 36 months after extracorporeal membrane oxygenation. "Before extracorporeal membrane oxygenation" variables (oxygenation index, pH, oxygen arterial partial pressure) and "during extracorporeal membrane oxygenation" variables (pH, oxygen arterial partial pressure, duration of bypass, clotting activated time, electroencephalogram) were also analyzed. A negative neurologic outcome (Glasgow Outcome Score different from "good recovery" or neurodevelopmental score less than 70) 12 months after extracorporeal membrane oxygenation was documented in 8.3% of neonates and in 30% of children who survived. There was no further change in subsequent evaluations (24 and 36 months follow-up). The most abnormal electroencephalogram during extracorporeal membrane oxygenation, the first electroencephalogram, neuroimaging score, and somatosensory evoked potentials after extracorporeal membrane oxygenation treatment were associated with negative neurologic outcome. The study documented that neonates and children treated with extracorporeal membrane oxygenation require long-term follow-up; electroencephalogram, neuroimaging score, and somatosensory evoked potentials have prognostic value for abnormal neurologic outcome.
Amigoni
Angela
A
Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
Pettenazzo
Andrea
A
Biban
Paolo
P
Suppiej
Agnese
A
Freato
Federica
F
Zaramella
Patrizia
P
Zacchello
Franco
F
D000293:Adolescent; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology; D004569:Electroencephalography; D005071:Evoked Potentials / Q000502:physiology*; D015199:Extracorporeal Membrane Oxygenation; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D009422:Nervous System Diseases / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D014888:Wechsler Scales