Maternal distress and perceptions of infant development following extracorporeal membrane oxygenation and conventional ventilation for persistent pulmonary hypertension

Neurodevelopmental outcome and concurrent maternal distress were examined for infants who suffered persistent pulmonary hypertension at birth and were treated with either extracorporeal membrane oxygenation (ECMO) ( n = 19) or conventional ventilation (CV) ( n = 15). Mothers were asked to complete inventories assessing their infant's (mean age 8.74 months) developmental growth as well as their own psychological health. Relevant sociodemographic and treatment parameters were also entered into the analysis. The results indicated that ECMO and CV infants did not differ on developmental indices and impairment rates were 15–23% respectively, similar to previous reports, in addition, ECMO and CV mothers did not differ in their reports of psychological distress. Correlational analyses revealed that length of treatment for ECMO but not CV infants significantly predicted developmental delay and maternal distress. For CV mothers, maternal distress was associated with the perception of delayed language. The results are discussed in terms of the limited morbidity associated with ECMO and CV interventions and the possible role of a ‘vulnerable child syndrome’ in understanding the maternal-infant relationship following ECMO therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73367/1/j.1365-2214.1995.tb00410.x.pd

The effect of inhaled nitric oxide on the course of extracorporeal membrane oxygenation and the occurrence of hemorrhagic complications.

Item does not contain fulltextThis study evaluated the relation between prior inhaled nitric oxide (iNO) and the time to initiation and duration of treatment with veno-arterial extracorporeal membrane oxygenation (ECMO) and the occurrence of hemorrhagic complications. A retrospective study was conducted in 59 human newborns treated for respiratory insufficiency with ECMO over a 5-year period. Patients received iNO before ECMO (iNO group) or not (control group). Both groups were compared for patient characteristics, postnatal age at the initiation of ECMO, duration of ECMO treatment, and hemorrhagic complications. There were no significant differences between the iNO group and the control group for patient characteristics and medication use before the ECMO treatment, except for norepinephrine. There was no significant difference for postnatal age at the initiation of ECMO and mean duration of ECMO treatment. We found no statistically significant difference in hemorrhagic complications between both groups. This persisted after correction for diagnosis and ECMO run-time in linear logistic regression analysis. Inhaled nitric oxide before ECMO did not result in a significant delay in the initiation of ECMO or longer duration of the ECMO. There was no significant relationship between the use of prior iNO and the occurrence of hemorrhagic complications during the ECMO treatment

The psychological outcome of ECMO-eligible neonates with severe respiratory failure treated using conventional medical therapy

ObjectiveThe present study addressed a National Health and Medical Research Council (NHMRC) recommendation that the outcome of neonates who are treated conventionally for respiratory problems be further investigated before setting up additional extracorporeal membrane oxygenation (ECMO) centres in Australia.MethodologyThe cognitive and behavioural outcome of ECMO eligible infants who received conventional treatment for respiratory problems at birth was assessed in 18 infants aged 1.5-3 years (index group). ECMO was not available at either of the treating hospitals. Index children were compared to a matched control group of children who did not experience any major complications at birth. Children were assessed using either the Bayley or McCarthy scales of infant development and the Child Behavior Checklist.ResultsOverall, a mortality rate of 19% and a psychological morbidity rate of 18% suggest that children born with severe respiratory failure, who meet existing ECMO eligibility criteria, have a good prognosis when treated using conventional medical therapy.ConclusionsImprovements to conventional treatments indicate that ECMO eligibility criteria may need to be revised to identify accurately those infants who are at extreme risk of mortality if treated conventionally