Congenital diaphragmatic hernia with(out) ECMO: impaired development at 8 years

Abstract

Objective: To evaluate developmental and social-emotional outcomes at 8 years of age for children with congenital diaphragmatic hernia (CDH), treated with or without neonatal extracorporeal membrane oxygenation (ECMO) between January 1999 and December 2003.

Design: Cohort study with structural prospective follow-up.

Setting: Level III University Hospital.

Patients: 35 children (ECMO: n=16; non-ECMO: n=19) were assessed at 8 years of age.

Interventions: None.

Main outcome measures: Intelligence and motor function. Concentration, behaviour, school performance, competence and health status were also analysed.

Results: Mean (SD) intelligence for the ECMO group was 91.7 (19.5) versus 111.6 (20.9) for the non-ECMO group (p=0.015). Motor problems were apparent in 16% of all participants and differed significantly from the norm (p=0.015) without differences between treatment groups. For all participants, problems with concentration (68%, p<0.001) and with behavioural attention (33%, p=0.021) occurred more frequently than in reference groups, with no difference between treatment groups. School performance and competence were not affected.

Conclusions: Children with CDH-whether or not treated with neonatal ECMO-are at risk for long-term morbidity especially in the areas of motor function and concentration. Despite their impairment, children with CDH have a well-developed feeling of self-competence.

Keywords: Congenital Abnorm; Ecmo; Intensive Care; Neurodevelopment; Outcomes research.