PDF(Pubmed)
Abstract：
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.
METHODS: 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.
METHODS: 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.
摘要：
背景：体外膜氧合（ECMO）不仅显着提高重症新生儿的生存率，而且与长期神经发育问题有关。系统回顾有关接受ECMO治疗的新生儿和婴儿的神经发育结局的现有文献，专注于运动缺陷，认知障碍，感觉障碍，和发育迟缓。这篇综述旨在了解发病率，患病率,以及这些问题的危险因素,并探讨当前的护理管理对策。
方法：在PubMed，EMBASE,和WebofScience使用了一系列与ECMO相关的关键字和短语，新生儿,婴儿,和神经发育的各个方面。初步筛选包括审查标题和摘要，以排除不相关的文章，然后是对潜在相关文献的全文评估。根据研究方法和统计分析对每项研究的质量进行评估。此外，进行引文搜索以确定可能被忽视的研究。虽然重点主要是新生儿ECMO，由于新生儿特异性文献的可获得性有限,涉及儿童和成人的研究也被纳入.
结果：大约50％的新生儿在ECMO治疗后表现出不同程度的脑损伤，特别是在额叶和颞顶白质区域，常伴有神经系统并发症。18％-23％的新生儿在头24小时内癫痫发作。出血事件发生在27%-60%的ECMO手术中，高达33%的人可能经历缺血性中风。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，其他研究没有发现显著差异；因此，ECMO的影响尚不清楚。在认知方面，语言,和智力发展，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得分较低，以及潜在的语言和学习困难。这些研究强调早期发现和干预ECMO幸存者潜在发育问题的重要性。可能需要实施多学科后续计划，包括定期的神经运动和心理评估。总的来说,进一步多中心，大样本,需要进行长期随访研究,以确定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，使用更大的样本量进行验证。微调管理，综合护理,适当的患者选择，主动监控，营养支持,早期康复可能有助于改善这些婴儿的长期结局。
方法：在PubMed，EMBASE,和WebofScience使用了一系列与ECMO相关的关键字和短语，新生儿,婴儿,和神经发育的各个方面。初步筛选包括审查标题和摘要，以排除不相关的文章，然后是对潜在相关文献的全文评估。根据研究方法和统计分析对每项研究的质量进行评估。此外，进行引文搜索以确定可能被忽视的研究。虽然重点主要是新生儿ECMO，由于新生儿特异性文献的可获得性有限,涉及儿童和成人的研究也被纳入.
结果：大约50％的新生儿在ECMO治疗后表现出不同程度的脑损伤，特别是在额叶和颞顶白质区域，常伴有神经系统并发症。18％-23％的新生儿在头24小时内癫痫发作。出血事件发生在27%-60%的ECMO手术中，高达33%的人可能经历缺血性中风。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，其他研究没有发现显著差异；因此，ECMO的影响尚不清楚。在认知方面，语言,和智力发展，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得分较低，以及潜在的语言和学习困难。这些研究强调早期发现和干预ECMO幸存者潜在发育问题的重要性。可能需要实施多学科后续计划，包括定期的神经运动和心理评估。总的来说,进一步多中心，大样本,需要进行长期随访研究,以确定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，使用更大的样本量进行验证。微调管理，综合护理,适当的患者选择，主动监控，营养支持,早期康复可能有助于改善这些婴儿的长期结局。
