Survival and Neurodevelopmental Outcomes in Congenital Diaphragmatic Hernia Patients with Single versus Repeat Extracorporeal Membrane Oxygenation Runs

Maja Herco; Patrick Sloan; Adam Vogel; Jesse Vrecenak; Tasnim Najaf

doi:10.1055/a-1877-9225

Survival and Neurodevelopmental Outcomes in Congenital Diaphragmatic Hernia Patients with Single versus Repeat Extracorporeal Membrane Oxygenation Runs

Am J Perinatol. 2022 Aug 25. doi: 10.1055/a-1877-9225. Online ahead of print.

Authors

Maja Herco¹, Patrick Sloan², Adam Vogel³, Jesse Vrecenak⁴, Tasnim Najaf²

Affiliations

¹ Division of Neonatology, Department of Pediatrics, East Carolina University, Greenville, North Carolina.
² Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
³ Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
⁴ Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.

PMID: 35709727
DOI: 10.1055/a-1877-9225

Abstract

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

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

Results: 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 the 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 with CDH neonates who had not required ECMO. Motor composite scores were significantly lower in repeat ECMO run neonates as compared with 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 with 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.

Key points: · A repeat ECMO run is associated with further neurodevelopmental deficits in the motor domain.. · Survival is possible after repeat ECMO and is associated with increased length of hospital stay.. · Neurodevelopmental follow-up is critical for all CDH ECMO patients..