Background

Extracorporeal membrane oxygenation (ECMO) not only significantly improves survival rates in severely ill neonates but also is associated with long-term neurodevelopmental issues. To systematically review the available literature on the neurodevelopmental outcomes of neonates and infants who have undergone ECMO treatment, with a focus on motor deficits, cognitive impairments, sensory impairments, and developmental delays. This review aims to understand the incidence, prevalence, and risk factors for these problems and to explore current nursing care and management strategies.

Data sources

A comprehensive literature search was performed across PubMed, EMBASE, and Web of Science using a wide array of keywords and phrases pertaining to ECMO, neonates, infants, and various facets of neurodevelopment. The initial screening involved reviewing titles and abstracts to exclude irrelevant articles, followed by a full-text assessment of potentially relevant literature. The quality of each study was evaluated based on its research methodology and statistical analysis. Moreover, citation searches were conducted to identify potentially overlooked studies. Although the focus was primarily on neonatal ECMO, studies involving children and adults were also included due to the limited availability of neonate-specific literature.

Results

About 50% of neonates post-ECMO treatment exhibit varying degrees of brain injury, particularly in the frontal and temporoparietal white matter regions, often accompanied by neurological complications. Seizures occur in 18%–23% of neonates within the first 24 hours, and bleeding events occur in 27%–60% of ECMO procedures, with up to 33% potentially experiencing ischemic strokes. Although some studies suggest that ECMO may negatively impact hearing and visual development, other studies have found no significant differences; hence, the influence of ECMO remains unclear. In terms of cognitive, language, and intellectual development, ECMO treatment may be associated with potential developmental delays, including lower composite scores in cognitive and motor functions, as well as potential language and learning difficulties. These studies emphasize the importance of early detection and intervention of potential developmental issues in ECMO survivors, possibly necessitating the implementation of a multidisciplinary follow-up plan that includes regular neuromotor and psychological evaluations. Overall, further multicenter, large-sample, long-term follow-up studies are needed to determine the impact of ECMO on these developmental aspects.

Conclusions

The impact of ECMO on an infant’s nervous system still requires further investigation with larger sample sizes for validation. Fine-tuned management, comprehensive nursing care, appropriate patient selection, proactive monitoring, nutritional support, and early rehabilitation may potentially contribute to improving the long-term outcomes for these infants.

中文翻译：

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ECMO 后新生儿和婴儿的大脑发育

背景

体外膜肺氧合（ECMO）不仅可以显着提高重症新生儿的存活率，而且还与长期神经发育问题有关。系统回顾关于接受 ECMO 治疗的新生儿和婴儿神经发育结局的现有文献，重点关注运动缺陷、认知障碍、感觉障碍和发育迟缓。本综述旨在了解这些问题的发生率、患病率和危险因素，并探讨当前的护理和管理策略。

数据源

使用与 ECMO、新生儿、婴儿和神经发育各个方面相关的大量关键词和短语，在 PubMed、EMBASE 和 Web of Science 上进行了全面的文献检索。初步筛选包括审查标题和摘要以排除不相关的文章，然后对潜在相关文献进行全文评估。每项研究的质量都是根据其研究方法和统计分析进行评估的。此外，还进行了引文检索来识别可能被忽视的研究。尽管重点主要是新生儿 ECMO，但由于新生儿特定文献有限，涉及儿童和成人的研究也包括在内。

结果

约50%的新生儿在ECMO治疗后表现出不同程度的脑损伤，特别是额叶和颞顶白质区域，通常伴有神经系统并发症。 18%–23% 的新生儿在出生后 24 小时内会发生癫痫发作，27%–60% 的 ECMO 手术中会发生出血事件，其中高达 33% 的新生儿可能会发生缺血性中风。尽管一些研究表明 ECMO 可能会对听力和视觉发育产生负面影响，但其他研究发现没有显着差异；因此，ECMO 的影响仍不清楚。在认知、语言和智力发育方面，ECMO治疗可能与潜在的发育迟缓有关，包括认知和运动功能的综合评分较低，以及潜在的语言和学习困难。这些研究强调了早期发现和干预 ECMO 幸存者潜在发育问题的重要性，可能需要实施包括定期神经运动和心理评估在内的多学科随访计划。总体而言，还需要进一步的多中心、大样本、长期随访研究来确定ECMO对这些发育方面的影响。

结论

ECMO对婴儿神经系统的影响仍需要进一步研究和更大样本量的验证。精细的管理、全面的护理、适当的患者选择、主动监测、营养支持和早期康复可能有助于改善这些婴儿的长期结果。