NEURODEVELOPMENTAL OUTCOME AFTER NEONATAL EXTRACORPOREAL MEMBRANE-OXYGENATION

Objective: To determine the neurodevelopmental outcome of neonates who underwent extracorporeal membrane oxygenation (ECMO group) and simila rly critically ill newborns with a lower Oxygenation Index who underwe nt conventional treatment (comparison group), and to determine whether factors such as the underlying diagnosis and the distance transported from outlying areas affect outcome. Design: Multicentre prospective l ongitudinal comparative outcome study. Setting: An ECMO centre providi ng services to all of western Canada and four tertiary care neonatal f ollow-up clinics. Subjects: All neonates who received treatment betwee n February 1989 and January 1992 at the Western Canadian Regional ECMO Center and who were alive at 2 years of age; 38 (95%) of the 40 survi ving ECMO-treated subjects and 26 (87%) of the 30 surviving comparison subjects were available for follow-up. Interventions: ECMO or convent ional therapy for respiratory failure. Outcome measures: Neurodevelopm ental disability (one or more of cerebral palsy, visual or hearing los s, seizures, severe cognitive disability), and mental and performance developmental indexes of the Bayley Scales of Infant Development. Resu lts: Six (16%) of the ECMO-treated children had neurodevelopmental dis abilities at 2 years of age, as compared with 1 (4%) of the comparison subjects; the difference was not statistically significant. The mean mental developmental index (91.8 [standard deviation (SD) 19.5] v. 100 .5 [SD 25.4]) and the mean performance developmental index (87.2 [SD 2 0.0] v. 96.4 [SD 20.9]) did not differ significantly between the ECMO group and the comparison group respectively. Among the ECMO-treated su bjects those whose underlying diagnosis was sepsis had the lowest Bayl ey indexes, significantly lower than those whose underlying diagnosis was meconium aspiration syndrome. The distance transported did not aff ect outcome. Conclusions: Neurodevelopmental disability and delay occu rred in both groups. The underlying diagnosis appears to affect outcom e, whereas distance transported does not. These findings support early transfer for ECMO of critically ill neonates with respiratory failure who do not respond to conventional treatment. Larger multicentre stud ies involving long-term follow-up are needed to confirm these findings .