Risk factors of impaired neuropsychological outcome in school-aged survivors of neonatal critical illness

Objective Until now, long-term outcome studies have focused on general cognitive functioning and its risk factors following neonatal extracorporeal membrane oxygenation (ECMO) and/or congenital diaphragmatic hernia (CDH). However, it is currently unknown which neuropsychological domains are most affected in these patients, and which clinical variables can be used to predict specific neuropsychological problems. This study aimed to identify affected neuropsychological domains and its clinical determinants in survivors of neonatal ECMO and/or CDH.
Design Prospective follow-up study.
Setting Tertiary university hospital.
Patients Sixty-five eight-year-old survivors of neonatal ECMO and/or CDH.
Interventions None.
Measurements and Main Results Intelligence, attention, memory, executive functioning and visuospatial processing were evaluated using validated tests and compared with Dutch reference data. Assessed risk factors of outcome were illness severity indicators, number of anesthetic procedures in the first year of life and growth at one year. Patients had average intelligence, but significantly poorer sustained attention, verbal and visuospatial memory than the norm. ECMO-treated CDH patients had significantly lower mean IQ than other neonatal ECMO patients and CDH patients not treated with ECMO. Maximum vasoactive-inotropic score was negatively associated with delayed verbal and visuospatial memory.
Conclusions We found memory and attention deficits in eight-year-old neonatal ECMO and CDH survivors. The maximum dose of vasoactive medication was negatively associated with verbal and visuospatial memory, which may suggest an effect of early cerebral hypoperfusion in determining these abnormalities.