Diagnosis-related deterioration of lung function after extracorporeal membrane oxygenation

Spoel, Marjolein; Laas, Roxanne; Gischler, Saskia J.; Hop, W. C. J.; Tibboel, Dick; Jongste, Johan C. de; IJsselstijn, Hanneke

doi:10.1183/09031936.00189911

Cited by 25 publications

(25 citation statements)

References 25 publications

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“…To our knowledge, only our group has previously reported on longitudinal lung function in children and young adults who survived CDH . In a study of ECMO‐treated patients with small numbers of CDH patients, lung function had deteriorated over time at school age .…”

Section: Discussionmentioning

confidence: 99%

“…6,8,20,21,33 The study populations of Haliburton et al 21 To our knowledge, only our group has previously reported on longitudinal lung function in children and young adults who survived CDH. 6,7 In a study of ECMO-treated patients with small numbers of CDH patients, lung function had deteriorated over time at school age. 7 In a cohort born before ECMO was introduced in the Netherlands (1991), mild airflow obstruction had deteriorated from childhood to young adulthood.…”

Section: Discussionmentioning

confidence: 99%

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Lung function in school‐aged congenital diaphragmatic hernia patients; a longitudinal evaluation

Toussaint-Duyster

Zijp

Spoel

et al. 2019

Pediatric Pulmonology

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Objective Children with congenital diaphragmatic hernia (CDH) are at risk for pulmonary morbidity. Data on longitudinal evaluation of lung function in CDH are scarce. We hypothesized that CDH patients would have impaired lung function that worsens over time. We evaluated lung function and its determinants at ages 8 and 12 years. Methods Dynamic and static lung volumes, and diffusion capacity were measured. Extracorporeal membrane oxygenation (ECMO) treatment, the standardized European neonatal treatment protocol, patch repair, duration of ventilation, type of initial mechanical ventilation, and nitric oxide treatment were entered as covariates in linear mixed models with standard deviation score (SDS) lung function parameters (FEV1, FEF 25‐75, and K CO) as dependent variables. Results Seventy‐six children (27 ECMO‐treated) born between 1999 and 2009 performed 113 reliable lung function tests. Severity of airflow obstruction deteriorated significantly from age 8 to 12 years: estimated mean difference (95% confidence interval [CI]) SDS FEV1 was −0.57 (−0.79 to −0.36) and SDS FEF25‐75 was −0.63 (−0.89 to −0.37), both P < .001. Static lung volumes were within normal range and unchanged over time: estimated mean difference (95% CI) SDS TLC −0.27 (−0.58 to 0.04); P = .085. SDS KCO was below normal at 8 and 12 years and remained stable: −0.06 (−0.22 to 0.35); P = .648. These observations were irrespective of ECMO treatment. FEV1 and FEF25‐75 were negatively associated with duration of ventilation (P < .001). Baseline data were not related with TLC or KCO. Conclusions CDH patients should be followed into adulthood as they are at risk for worsening airflow obstruction and decreased diffusion capacity at school age, irrespective of ECMO treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lung function in school‐aged congenital diaphragmatic hernia patients; a longitudinal evaluation

Toussaint-Duyster

Zijp

Spoel

et al. 2019

Pediatric Pulmonology

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“…This confirms our earlier observations in 35 eightyear-old CDH survivors who had longterm problems with motor function and concentration, even when they had not been treated with ECMO. 21 A high presence of CLD and increased airflow obstruction that deteriorates over time 22 may contribute to poor motor function performance in these CDH patients.…”

Section: Discussionmentioning

confidence: 99%

Motor Performance After Neonatal Extracorporeal Membrane Oxygenation: A Longitudinal Evaluation

Zijp¹,

Janssen

Raets

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: After neonatal extracorporeal membrane oxygenation treatment, children are at risk for neurodevelopmental problems including delayed motor function. So far this has only been studied cross-sectionally until age 7 years. WHAT THIS STUDY ADDS:We describe, in a nationwide evaluation, the longitudinal course of motor function development after neonatal extracorporeal membrane oxygenation with persisting problems up to 12 years. At risk are children with congenital diaphragmatic hernia and those with chronic lung disease. abstract OBJECTIVE: To assess longitudinally children' s motor performance 5 to 12 years after neonatal extracorporeal membrane oxygenation (ECMO) and to evaluate associations between clinical characteristics and motor performance. METHODS:Two hundred fifty-four neonatal ECMO survivors in the Netherlands were tested with the Movement Assessment Battery for Children at 5, 8, and/or 12 years. Percentile scores were transformed to z scores for longitudinal evaluation (norm population mean = 0 and SD = 1). Primary diagnoses: meconium aspiration syndrome (n = 137), congenital diaphragmatic hernia (n = 49), persistent pulmonary hypertension of the newborn (n = 36), other diagnoses (n = 32). RESULTS:Four hundred fifty-six tests were analyzed. At 5, 8, and 12 years motor performance was normal in 73.7, 74.8, and 40.5%, respectively (vs 85% expected based on reference values; P , .001 at all ages). In longitudinal analyses mean (95% confidence interval [CI]) z scores were -0.42 (-0.55 to -0.28), -0.25 (-0.40 to -0.10) and -1.00 (-1.26 to -0.75) at 5, 8, and 12 years, respectively. Mean score at 8 years was significantly higher than at 5 years (difference 0.16, 95% CI 0.02 to 0.30), and mean score at 12 years was significantly lower than at both other ages (differences -0.59 and -0.75; 95% CI -0.33 to -0.84 and -0.49 to -1.00, respectively). Children with congenital diaphragmatic hernia encountered problems at all ages. The presence of chronic lung disease was negatively related with outcome.CONCLUSIONS: Motor problems in neonatal ECMO survivors persist throughout childhood and become more obvious with time. Pediatrics 2014;134:e427-e435 AUTHORS:

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“…In previous studies, we showed that children born with major anatomical foregut anomalies and/or treated with ECMO are at risk for long‐term respiratory morbidity, reduced exercise capacity, and even deterioration of exercise capacity . In this RCT, we aimed to evaluate whether these children's exercise capacity can be improved.…”

Section: Perspectivementioning

confidence: 99%

“…Children born with major anatomical foregut anomalies, for example, congenital diaphragmatic hernia (CDH), esophageal atresia (EA), and congenital pulmonary airway malformation (CPAM), may require treatment with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure. Also, neonates without congenital anatomical anomalies (CAA) may require ECMO, for example, meconium aspiration syndrome or sepsis …”

Section: Introductionmentioning

confidence: 99%

Improvement of exercise capacity following neonatal respiratory failure: A randomized controlled trial

Toussaint-Duyster

Zijp

Takken

et al. 2019

Scandinavian Med Sci Sports

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Exercise capacity deteriorates in school‐aged children born with major anatomical foregut anomalies and/or treated with extracorporeal membrane oxygenation. The aim of the present study was to evaluate whether exercise capacity can be improved in the short term and long term in children born with anatomical foregut anomalies and/or treated with extracorporeal membrane oxygenation. Therefore, we evaluated two different interventions in this single‐blinded randomized controlled trial. Forty participants were randomly assigned to group A: standardized anaerobic high‐intensity interval training plus online lifestyle coaching program, B: online lifestyle coaching program only, or C: standard of care. Inclusion criteria were as follows: score ≤−1 standard deviation (SD) on the Bruce protocol. Exercise capacity was assessed at baseline (T0), after 3 months (T1), and after 12 months (T2). Exercise capacity improved over time: mean (SD) standard deviation score (SDS) endurance time: T0 −1.91 (0.73); T1 −1.35 (0.94); T2 −1.20 (1.03): both P < .001. No significant differences in maximal endurance time were found at T1 (group A‐C: estimated mean difference (SDS): 0.06 P = .802; group B‐C: −0.17 P = .733) or T2 (group A‐C: −0.13 P = .635; group B‐C: −0.18 P = .587). Exercise capacity improved significantly over time, irrespective of the study arm. Not only residual morbidities may be responsible for reduced exercise capacity. Parental awareness of reduced exercise capacity rather than specific interventions may have contributed. Monitoring of exercise tolerance and providing counseling on lifestyle factors that improve physical activity should be part of routine care, and aftercare should be offered on an individual basis.

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Diagnosis-related deterioration of lung function after extracorporeal membrane oxygenation

Cited by 25 publications

References 25 publications

Lung function in school‐aged congenital diaphragmatic hernia patients; a longitudinal evaluation

Lung function in school‐aged congenital diaphragmatic hernia patients; a longitudinal evaluation

Motor Performance After Neonatal Extracorporeal Membrane Oxygenation: A Longitudinal Evaluation

Improvement of exercise capacity following neonatal respiratory failure: A randomized controlled trial

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