Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

Schiller, Raisa M.; Tibboel, Dick

doi:10.3389/fped.2019.00494

Cited by 9 publications

(7 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding may reflect the greater disease severity, greater intensity of PICU treatments, and/or greater intensity of surgical treatment(s) of children admitted after heart- or heart–lung transplantation. The results on the PICU subgroups in the current study are in line with earlier literature overviews [ 36 – 42 ] and extend these findings by the unique focus on children admitted to the PICU and by providing comprehensive meta-analytic quantification of intelligence impairment.…”

Section: Discussionsupporting

confidence: 90%

Intelligence outcome of pediatric intensive care unit survivors: a systematic meta-analysis and meta-regression

Sonnaville

Königs

Leijden

et al. 2022

BMC Med

View full text Add to dashboard Cite

Background Long-term morbidity after pediatric intensive care unit (PICU) admission is a growing concern. Both critical illness and accompanying PICU treatments may impact neurocognitive development as assessed by its gold standard measure; intelligence. This meta-analysis and meta-regression quantifies intelligence outcome after PICU admission and explores risk factors for poor intelligence outcome. Methods PubMed, Embase, CINAHL and PsycINFO were searched for relevant studies, published from database inception until September 7, 2021. Using random-effects meta-analysis, we calculated the standardized mean difference in full-scale intelligence quotient (FSIQ) between PICU survivors and controls across all included studies and additionally distinguishing between PICU subgroups based on indications for admission. Relation between demographic and clinical risk factors and study’s FSIQ effect sizes was investigated using random-effects meta-regression analysis. Results A total of 123 articles was included, published between 1973 and 2021, including 8,119 PICU survivors and 1,757 controls. We found 0.47 SD (7.1 IQ-points) lower FSIQ scores in PICU survivors compared to controls (95%CI -0.55 to -0.40, p < .001). All studied PICU subgroups had lower FSIQ compared to controls (range 0.38–0.88 SD). Later year of PICU admission (range 1972–2016) and longer PICU stay were related to greater FSIQ impairment (R2 = 21%, 95%CI -0.021 to -0.007, p < .001 and R2 = 2%, 95%CI -0.027 to -0.002, p = .03, respectively), whereas male sex and higher rate of survivors were related to smaller FSIQ impairment (R2 = 5%, 95%CI 0.001 to 0.014, p = .03 and R2 = 11%, 95%CI 0.006 to 0.022, p < .001, respectively). Meta-regression in PICU subgroups showed that later year of PICU admission was related to greater FSIQ impairment in children admitted after cardiac surgery and heart- or heart–lung transplantation. Male sex was related to smaller FSIQ impairment in children admitted after cardiac surgery. Older age at PICU admission and older age at follow-up were related to smaller FSIQ impairment in children admitted after heart- or heart–lung transplantation. Conclusions PICU survivors, distinguished in a wide range of subgroups, are at risk of intelligence impairment. Length of PICU stay, female sex and lower rate of survivors were related to greater intelligence impairment. Intelligence outcome has worsened over the years, potentially reflecting the increasing percentage of children surviving PICU admission.

show abstract

Section: Discussionsupporting

confidence: 90%

Intelligence outcome of pediatric intensive care unit survivors: a systematic meta-analysis and meta-regression

Sonnaville

Königs

Leijden

et al. 2022

BMC Med

View full text Add to dashboard Cite

show abstract

“…The most relevant brain regions (significant higher FA and significant lower RD in no-ECMO group – Fig. 4) we found in the individual FA and RD values support the findings on impairment in neurodevelopmental outcome later in life reported by others [11; 12; 15; 16; 17; 23; 24; 49; 50; 51; 52] which are a) motor dysfunction (corpus callosum and anterior limb of internal capsule), b) visuo-spatial problems (corpus callosum and anterior commissure) c) memory problems (crus of fornix and uncinate fasciculus) and d) attention problems (anterior corona radiata and anterior commissure). The three parts of the corpus callosum (genu, body and splenium) connect the two cerebral hemispheres and are known to be involved in movement control, cognitive functions and vision.…”

Section: Discussionsupporting

confidence: 89%

White Matter Integrity Differences in 2-year-old Children Treated with ECMO: A Diffusion-Weighted Imaging Study

Ruttorf,

Filip,

Schaible

et al. 2024

Preprint

View full text Add to dashboard Cite

School-aged and adolescent survivors of neonatal extracorporeal membrane oxygenation (ECMO) treatment still suffer from neurodevelopmental delays such as verbal, visuo-spatial and working memory problems, motor dysfunction and sensorineural hearing loss, respectively, later in life. These neurodevelopmental delays are normally assessed by neuropsychological testing within follow-up programs. The purpose of this study is to demonstrate that diffusion-weighted imaging (DWI) in 2-year-old survivors of neonatal ECMO treatment might be a predictor of neurodevelopmental outcome. Therefore, 56 children underwent DWI at 3 T. Fractional anisotropy (FA), first fibre partial volume fraction estimate (F1) and radial diffusivity (RD) are compared using tract-based spatial statistics adapted to a paediatric brain atlas and whole-brain voxelwise statistics with age and gender as covariates of no interest. A significant difference in FA, F1 and RD between no-ECMO and ECMO group is seen in major white matter tracts and subcortical white matter in gyri leading to the conclusion that these differences are driven by alterations in axon coherence. Additionally, we examine individual diffusion measures by looking at masks from 50 brain regions taken from a paediatric brain atlas. We find left anterior corona radiata, left and right corpus callosum (genu, body and splenium), left and right crus of fornix, left anterior limb of internal capsule, left anterior commissure, left tapetum and right uncinate fasciculus to have significantly different means in no-ECMO compared to ECMO group which matches the reports of neuropsychological delays found in behavioural tests. To conclude, analysing diffusion measures at an early stage of life serves as a good tool to detect structural white matter changes in survivors of neonatal ECMO treatment like lacking axon coherence in fibre bundles which develop early in life. The advantage of DWI lies in looking only at the neurobiology, e.g. white matter integrity. Compared to neuropsychological testing, DWI in this age range is a very time-efficient method which does not depend on the child’s active participation. Additional targeted training could help to mitigate the neurodevelopmental deficits ECMO survivors face later in life.

show abstract

“…No significant difference was found in the intelligence quotient between the reconstruction and ligation group ( 8 , 46 ). Long-term neuropsychological deficits were associated with the underlying disease processes in the neonatal period instead of with ECMO treatment ( 47 ). In contrast, some studies found that the duration of ECMO treatment was associated with ANI in children, while the long-term neurological prognosis was favorable ( 48 ).…”

Section: Evaluation Of the Nervous System After Reconstruction Or Lig...mentioning

confidence: 99%

ECMO in neonates: The association between cerebral hemodynamics with neurological function

Mao

et al. 2022

Front. Pediatr.

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation (ECMO) is a superior life support technology, commonly employed in critical patients with severe respiratory or hemodynamic failure to provide effective respiratory and circulatory support, which is especially recommended for the treatment of critical neonates. However, the vascular management of neonates with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is still under controversy. Reconstruction or ligation for the right common carotid artery (RCCA) after ECMO is inconclusive. This review summarized the existed studies on hemodynamics and neurological function after vascular ligation or reconstruction hoping to provide better strategies for vessel management in newborns after ECMO. After reconstruction, the right cerebral blood flow can increase immediately, and the normal blood supply can be restored rapidly. But the reconstructed vessel may be occluded and stenotic in long-term follow-ups. Ligation may cause lateralization damage, but there could be no significant effect owing to the establishment of collateral circulation. The completion of the circle of Willis, the congenital anomalies of cerebral or cervical vasculature, the duration of ECMO, and the vascular condition at the site of arterial catheterization should be assessed carefully before making the decision. It is also necessary to follow up on the reconstructed vessel sustainability, and the association between cerebral hemodynamics and neurological function requires further large-scale multi-center studies.

show abstract

Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

Cited by 9 publications

References 59 publications

Intelligence outcome of pediatric intensive care unit survivors: a systematic meta-analysis and meta-regression

Intelligence outcome of pediatric intensive care unit survivors: a systematic meta-analysis and meta-regression

White Matter Integrity Differences in 2-year-old Children Treated with ECMO: A Diffusion-Weighted Imaging Study

ECMO in neonates: The association between cerebral hemodynamics with neurological function

Contact Info

Product

Resources

About