title: Diagnosis-related deterioration of lung function after extracorporeal membrane oxygenation.
abstract: The aim of the study was to assess lung function longitudinally after neonatal extracorporeal membrane oxygenation (ECMO), and to identify any effects of diagnosis and perinatal characteristics. 121 neonatal ECMO-treated children (70 with meconium aspiration syndrome, 20 congenital diaphragmatic hernia and 31 with other diagnoses) performed a total of 191 lung function measurements at 5, 8 and/or 12 yrs. We assessed dynamic and static lung volumes, reversibility of airway obstruction and diffusion capacity. Mean SDS forced expiratory volume in 1 s (FEV(1)) at 5 yrs before and after bronchodilation (-0.51 and 0.07) was significantly higher than at 8 (-0.79 and -0.4; p<0.04) and 12 yrs (-1.10 and -0.52; p<0.003). Mean SDS for all spirometric parameters before and after bronchodilation were significantly lower in the congenital diaphragmatic hernia group compared with the other diagnostic groups (all p ≤ 0.025). A significant volume of trapped air was observed in 86% patients with congenital diaphragmatic hernia, 50% with meconium aspiration syndrome and 58% with other diagnoses. After bronchodilation, mean SDS FEV(1) and forced vital capacity were negatively influenced by duration of ventilation (both p<0.001) and duration of ECMO (p=0.003 and p=0.02, respectively). Long-term pulmonary sequelae after neonatal ECMO-treatment mainly occur in congenital diaphragmatic hernia patients and tend to deteriorate over time.
authors.affiliation: Intensive Care and Dept of PediatricSurgery, Erasmus MC – SophiaChildren’s Hospital, Rotterdam, The Netherlands. m.spoel@erasmusmc.nl
authors.forename: Marjolein
authors.initials: M
authors.lastname: Spoel
authors.forename: Roxanne
authors.initials: R
authors.lastname: Laas
authors.forename: Saskia J
authors.initials: SJ
authors.lastname: Gischler
authors.forename: Wim J C
authors.initials: WJ
authors.lastname: Hop
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.forename: Hanneke
authors.initials: H
authors.lastname: Ijsselstijn
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006548:Hernia, Diaphragmatic / Q000473:pathology / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000473:pathology* / Q000628:therapy*; D011446:Prospective Studies; D013147:Spirometry / Q000379:methods; D016896:Treatment Outcome; D014797:Vital Capacity