Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1292-1296 (doi:10.1542/peds.2003-1080-L)

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Long-Term Pulmonary Sequelae in Children Who Were Treated With Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure

Refika Hamutcu, MD, Toni A. Nield, PT, MA, PCS, Meena Garg, MD, Thomas G. Keens, MD and Arnold C.G. Platzker, MD

From the Divisions of Pediatric Pulmonology and Neonatal Medicine, Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California

Objective. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for neonates with intractable respiratory failure, but the long-term pulmonary outcome is unknown. Our aim was to investigate the long-term pulmonary sequelae of these children.

Study Design. We studied 50 children at 11.1 ± 1.1 years (mean ± SD) who had been treated with neonatal ECMO for meconium aspiration syndrome (38%), sepsis (18%), sepsis with pneumonia (12%), congenital diaphragmatic hernia (12%), congenital heart disease (8%), persistent pulmonary hypertension of the newborn (6%), and respiratory distress syndrome (4%) and 27 healthy controls (10.8 ± 1.6 years). All subjects completed a respiratory questionnaire and performed pulmonary function and graded cardiopulmonary exercise testing.

Results. Neonatal ECMO survivors had hyperinflation (median residual volume: 131%), airway obstruction (median forced expired volume in 1 second: 79%), lower oxygen saturation with exercise, and lower peak oxygen consumption than controls. The ECMO group achieved similar exercise minute ventilation to controls, with more rapid and shallow breathing. ECMO survivors had an increased frequency of exercise-induced bronchospasm. Those who required higher inspired oxygen tension and ventilator pressures after weaning from ECMO had lower forced expired volume in 1 second and oxygen saturation values.

Conclusion. Neonatal ECMO survivors experience lung injury lasting into later childhood. Lung dysfunction correlates with the extent and duration of barotrauma and oxygen exposure as neonates.

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Key Words: ECMO • cardiopulmonary exercise test • pulmonary sequela

Abbreviations: ECMO, extracorporeal membrane oxygenation • MAS, meconium aspiration syndrome • CDH, congenital diaphragmatic hernia • CHLA, Childrens Hospital Los Angeles • E, minute ventilation • SPO₂, oxygen saturation • CO₂, carbon dioxide production • O₂, oxygen consumption • RQ, respiratory exchange ratio • OI, oxygen index • FIO₂, fraction of inspired oxygen • RV, residual volume • FEV₁, forced expired volume in 1 second • FEF_25%–75%, forced expiratory flow between 25% and 75% of vital capacity • TLC, total lung capacity • V_T, tidal volume

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Accepted May 6, 2004.

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