title: Follow-up of newborns treated with extracorporeal membrane oxygenation: a nationwide evaluation at 5 years of age.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is a supportive cardiopulmonary bypass technique for babies with acute reversible cardiorespiratory failure. We assessed morbidity in ECMO survivors at the age of five years, when they start primary school and major decisions for their school careers must be made.
  
  
  METHODS
  Five-year-old neonatal venoarterial-ECMO survivors from the two designated ECMO centres in The Netherlands (Erasmus MC--Sophia Children's Hospital in Rotterdam, and University Medical Center Nijmegen) were assessed within the framework of an extensive follow-up programme. The protocol included medical assessment, neuromotor assessment, and psychological assessment by means of parent and teacher questionnaires.
  
  
  RESULTS
  Seventeen of the 98 children included in the analysis (17%) were found to have neurological deficits. Six of those 17 (6% of the total) showed major disability. Two of those six children had a chromosomal abnormality. Three were mentally retarded and profoundly impaired. The sixth child had a right-sided hemiplegia. These six children did not undergo neuromotor assessment. Twenty-four of the remaining 92 children (26%) showed motor difficulties: 15% actually had a motor problem and 11% were at risk for this. Cognitive delay was identified in 11 children (14%). The mean IQ score was within the normal range (IQ = 100.5).
  
  
  CONCLUSIONS
  Neonatal ECMO in The Netherlands was found to be associated with considerable morbidity at five years of age. It appeared feasible to have as many as 87% of survivors participate in follow-up assessment, due to cooperation between two centres and small travelling distances. Objective evaluation of the long-term morbidity associated with the application of this highly invasive technology in the immediate neonatal period requires an interdisciplinary follow-up programme with nationwide consensus on timing and actual testing protocol.
authors.affiliation: Department of Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands. mn_hanekamp@hotmail.com
authors.forename: Manon N
authors.initials: MN
authors.lastname: Hanekamp
authors.forename: Petra
authors.initials: P
authors.lastname: Mazer
authors.forename: Monique H M
authors.initials: MH
authors.lastname: van der Cammen-van Zijp
authors.forename: Boudien J M
authors.initials: BJ
authors.lastname: van Kessel-Feddema
authors.forename: Maria W G
authors.initials: MW
authors.lastname: Nijhuis-van der Sanden
authors.forename: Simone
authors.initials: S
authors.lastname: Knuijt
authors.forename: Jessica L A
authors.initials: JL
authors.lastname: Zegers-Verstraeten
authors.forename: Saskia J
authors.initials: SJ
authors.lastname: Gischler
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Louis A A
authors.initials: LA
authors.lastname: Kollée
mesh_terms: D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology; D009426:Netherlands / Q000453:epidemiology; D049590:Postpartum Period / Q000235:genetics / Q000502:physiology