Clinical and respiratory functional follow-up in 39 infants treated by respiratory extracorporeal assistance during the neonatal period

The aim of this prospective study was to evaluate the consequences of neona tal treatment with a venovenous. extracorporeal respiratory assistance. Population and methods, - Thirty nine neonates (28 boys) with acute respira tory failure were included. Extracorporeal respiratory assistance consisted of an apnoeic oxygenation with low frequency positive pressure ventilation and extracorporeal membrane CO2 removal through a venous single canula per fusion circuit. The causes of respiratory distress were: 15 meconium aspira tion syndrome, 12 respiratory distress syndrome, sir hyaline membrane disea se, three sepsis, two diaphragmatic hernia, and one post-surgery Mendelson syndrome. The mean duration of mechanical ventilation was 18 days, includin g 5 days of extracorporeal respiratory assistance. The prospective follow-u p included physical examination, chest radiographs, scintigraphy and pulmon ary function tests. These tests studied the following parameters: functiona l residual capacity by helium dilution technique, lung resistance and dynam ic lung compliance by the esophageal balloon technique and blood gases with arterialized blood samples. Results. - The mean duration of the follow-up was 21.3 months (6 months to 5 years). Results showed in the first year 33% of children with chronic obs tructive pulmonary disease and chest X-ray abnormalities, such as bronchopu lmonary dysplasia in 23% of children. Data of pulmonary function test at th e end of the first year: lung resistance and functional residual capacity w ere within limits of predicted values for height, and dynamic lung complian ce was slightly decreased; according to the analysis of the functional prof ile: 31% without abnormality, 41% of obstructive syndrome and 26% with rest rictive pattern. Blood gases were normal in 37 children. Ar the end of the second year, we noticed normal functional residual capacity, an increase of lung resistance while lung compliance was normalized; functional profile w as quite different: with a decrease of the number of patients without abnor mality (22%) and increase of those with obstructive syndrome (56%). Conclusion. - The percentage of abnormalities is high but these are moderat e in most cases, especially if we compare with the initial seriousness of t he pulmonary pathology. We suggest a regular follow-up to study the respect ive incidence of pulmonary disease and/or extracorporeal respiratory assist ance over these abnormalities. (C) 1999 Elsevier, Paris.