Neuropsychological Follow-up After Neonatal ECMO

OBJECTIVE: To assess the longitudinal development of intelligence and its relation to school performance in a nationwide cohort of neonatal extracorporeal membrane oxygenation (ECMO) survivors and evaluate predictors of outcome at 8 years of age. METHODS: Repeated measurements assessed intelligence of neonatal ECMO survivors at 2, 5, and 8 years (n = 178) with the use of validated, standardized instruments. Selective attention (n = 148) and type of education were evaluated in the 8-year-olds. RESULTS: Intelligence remained stable and average across development (mean +/- SD IQ: at 2 years, 102 +/- 18; at 5 years, 100 +/- 17; and at 8 years, 99 +/- 17 [P =.15]). Children attending regular education without the need for help (n = 101; mean z score: -1.50 +/- 1.93) performed significantly better on the selective attention task compared with those children who needed extra help (n = 65; mean z score: -2.54 +/- 3.18) or those attending special education (n = 13; mean z score: -4.14 +/- 3.63) (P =.03). However, only children attending special education had below-average intelligence (mean IQ: 76 +/- 15), compared with average intelligence for those attending regular education, both with help (mean IQ: 95 +/- 15) and without help (mean IQ: 105 +/- 16). Compared with children with other diagnoses, children with congenital diaphragmatic hernia (CDH) scored significantly lower on both IQ (CDH, mean IQ: 93 +/- 20; meconium aspiration syndrome, mean IQ: 100 +/- 15; other diagnoses, mean IQ: 100 +/- 19 [P =.04]) and selective attention (CDH, mean z score: -3.48 +/- 3.46; meconium aspiration syndrome, mean z score: -1.60 +/- 2.13; other diagnoses, mean z score: -1.65 +/- 2.39 [P =.002]). CONCLUSIONS: For the majority of neonatal ECMO survivors, intelligence testing alone did not identify those at risk for academic problems. We propose internationally standardized follow-up protocols that focus on long-term, problem-oriented neuropsychological assessment.