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Research: Survival and Neurodevelopmental Outcomes in Congenital Diaphragmatic Hernia Patients with Single versus Repeat ECMO Runs

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Research: Survival and Neurodevelopmental Outcomes in Congenital Diaphragmatic Hernia Patients with Single versus Repeat ECMO Runs

Am J Perinatol

. 2022 Jun 16.

 doi: 10.1055/a-1877-9225. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/35709727/

Survival and Neurodevelopmental Outcomes in Congenital Diaphragmatic Hernia Patients with Single versus Repeat ECMO Runs

Maja Herco 1Patrick Sloan 2Adam Vogel 3Jesse Vrecenak 4Tasnim Najaf 5

Affiliations expand

Abstract

Objective: We describe the survival and neurodevelopmental outcomes of congenital diaphragmatic hernia (CDH) patients who received single and repeat ECMO.

Study design: A retrospective single-center study comparing neurodevelopmental outcomes in CDH patients who were managed without ECMO, one ECMO run, and those who received two ECMO runs. Neurodevelopmental testing was performed utilizing the Bayley Scales of Infant Development-III.

Result: There were 68 neonates identified with CDH from January 2011 to June 2019, 30 did not receive ECMO, 29 received single ECMO run and 9 received two ECMO runs. Survival of ECMO patients was 50%, with 48% of single run and 57% of repeat run patients surviving to discharge. Second run ECMO patients had increased median ventilator days (60 vs 33, p=0.04) and increased median length of hospital stay (159 vs 89 p=0.01). Neurodevelopmental testing via Bayley Scales of Infant Development-III was performed on 74% of survivors at mean age of 24 months. CDH neonates who underwent ECMO (single or repeat runs) were more likely to have lower cognitive, language, and motor composite scores as compared to CDH neonates who had not required ECMO. Motor composite scores were significantly lower in repeat ECMO run neonates as compared to single ECMO run (72+ 6 vs. 85+4, p=0.0003), but there were no further deficits noted in language or cognitive domains.

Conclusion: Survival after a second ECMO run in CDH is possible although with increased ventilator days and increased length of hospitalization. We also find further deficits in motor outcomes in the second run ECMO group compared to single run ECMO. Our findings do not preclude a second ECMO run, but rather inform our counseling to families and reinforce the need for close neurodevelopmental follow-up for these patients.

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