目的:支气管肺发育不良(BPD)的早产儿是先前被认为是ECLS(体外生命支持)高危候选者的一个亚组,原因是怀疑高死亡率或ECLS后发病率增加。这项研究的目的是确定具有确定的BPD病史的患者随后需要ECLS的结果。
方法:2010-2022年01月06日对2岁以下的患者进行了单中心回顾性研究,早产(<32周),随后诊断为BPD,和谁需要ECLS呼吸衰竭。人口统计学和临床数据,包括ECLS数据,被收集。演讲,语言,喂食/吞咽,认知,听力,愿景,或在出院后的中位随访时间为42个月,获得了运动功能缺陷。
结果:19例患者符合标准。中位出生体重和胎龄为0.86kg(IQR0.73,1.0)和26周(IQR25,27),分别。插管时的中位实际年龄为12.1个月。需要ECLS的呼吸衰竭最常见的病因是病毒性(68.4%)和细菌性(21.1%)肺炎。拔管生存率为78.9%(15/19),出院生存率为63.2%(12/19)。在要出院的幸存者中,42%(5/12)需要新的或额外的家庭氧气,50%(6/12)在1年的随访中有神经发育/行为方面的担忧,25%(3/12)的担忧超过一年。
结论:需要ECLS的基础BPD患者与非BPD合并呼吸衰竭患者相比,死亡率和长期神经发育结局相当。在考虑ECLS候选人资格和提供家庭咨询时,此信息可能很有用。
OBJECTIVE: Preterm pediatric patients with bronchopulmonary dysplasia (BPD) represent a subgroup previously deemed high risk candidates for ECLS (extracorporeal life support) due to suspected high mortality or increased post ECLS morbidity. The aim of this study was to determine outcomes for patients with an established history of BPD who subsequently required ECLS.
METHODS: A single center retrospective review was performed between 01/2010-06/2022 for patients less than 2 years of age, born prematurely (<32 weeks) with a subsequent diagnosis of BPD, and who required ECLS for respiratory failure. Demographic and clinical data, including ECLS data, were collected. Speech, language, feeding/swallowing, cognitive, hearing, vision, or motor function deficits were obtained with a median follow up of 42 months following discharge.
RESULTS: Nineteen patients met criteria. The median birth weight and gestational age was 0.86 kg (IQR 0.73, 1.0) and 26 weeks (IQR 25, 27), respectively. The median chronological age at cannulation was 12.1 months. The most common etiologies for respiratory failure requiring ECLS were viral (68.4%) and bacterial (21.1%) pneumonia. Survival to decannulation was 78.9% (15/19) and survival to hospital discharge was 63.2% (12/19). Amongst survivors to discharge, 42% (5/12) required new or additional home oxygen and 50% (6/12) were noted to have neurodevelopmental/behavioral concerns on follow up at 1 year with 25% (3/12) with concerns beyond a year.
CONCLUSIONS: Patients with underlying BPD who require ECLS have comparable mortality and long-term neurodevelopmental outcomes to non-BPD patients with respiratory failure. This information can be useful when considering ECLS candidacy and providing family counseling.