背景:体外膜氧合(ECMO)已广泛用于严重的新生儿疾病约50年,虽然很少有研究集中在其神经心理学发育的长期随访上。
目的:评估婴儿期接受ECMO的儿童的长期神经心理并发症。
方法:PubMed,WebofScience,科克伦,和EMBASE数据库检索最近10年(直到2022年6月10日)发表的研究。所有研究均符合资格,集中于接受ECMO的新生儿的神经心理学并发症的长期随访。不包括动物研究,先天性颅脑发育不良的新生儿和来自同一中心的数据在不同时间进行的研究。采用RevMan5.3和Stata/SE12.0软件进行统计分析。使用随机效应模型报告结果。敏感性分析用于确定异质性的来源。
结果:对纳入1199名患者的10项研究进行了荟萃分析,显示智力的合并发病率(合并发病率:20.3%,95%CI:0.16-0.25,I2:9.5%,P=0.33),运动活动(合并发病率:10.3%,95CI:0.07-0.14,I2:43.5%,P=0.15),学习(合并发病率:9.0%,95CI:-0.03-0.21,I2:63.2%,P=0.10),听力(合并发病率:15.7%,95CI:0.02-0.29,I2:94.2%,P=0.00),视力(合并发病率:18.5%,95CI:0.12-0.25,I2:0%,P=0.46),认知(合并发病率:26.3%,95CI:0.19-0.34,I2:0%,P=0.32),注意力(合并发病率:7.4%,95CI:0.02-0.13,I2:38.9%,P=0.20),注意速度(合并发病率:69.9%,95CI:0.62-0.78),和注意力的准确性(合并发病率:39.0%,95CI:0.30-0.48)在接受ECMO的新生儿中。Begg检验和敏感性分析的结果表明,异质性源于样本量以外的因素。
结论:这项系统综述和荟萃分析显示,接受ECMO的新生儿与各种神经心理并发症有关。需要更大样本量和更高质量的其他随机对照试验(RCT)。
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in severe neonatal diseases for approximately 50 years, while few studies have concentrated on the long-term follow-up of its neuropsychological development.
OBJECTIVE: To assess the long-term neuropsychological complications in children who underwent ECMO in infancy.
METHODS: The PubMed, Web of Science, Cochrane, and EMBASE databases were searched for retrieving studies published in the recent 10 years (until June 10, 2022). All studies were eligible that concentrated on the long-term follow-up of neuropsychological complications in neonates undergoing ECMO. Excluding animal studies, neonates with congenital craniocerebral dysplasia and studies with data from the same center performed at different times. Statistical analysis was performed using RevMan 5.3 and Stata/SE 12.0 software. A random-effects model was used to report results. The sensitivity analysis was utilized to identify sources of heterogeneity.
RESULTS: The meta-analysis of 10 studies that enrolled 1199 patients was conducted, showing the pooled morbidity of intelligence (pooled morbidity: 20.3%, 95% CI: 0.16-0.25, I2: 9.5%, P=0.33), motor activity (pooled morbidity: 10.3%, 95%CI: 0.07-0.14, I2: 43.5%, P=0.15), learning (pooled morbidity: 9.0%, 95%CI: -0.03-0.21, I2: 63.2%, P=0.10), hearing (pooled morbidity: 15.7%, 95%CI: 0.02-0.29, I2: 94.2%, P=0.00), vision (pooled morbidity: 18.5%, 95%CI: 0.12-0.25, I2: 0%, P=0.46), cognition (pooled morbidity: 26.3%, 95%CI: 0.19-0.34, I2: 0%, P=0.32), attention (pooled morbidity: 7.4%, 95%CI: 0.02-0.13, I2: 38.9%, P=0.20), speed in attention (pooled morbidity: 69.9%, 95%CI: 0.62-0.78), and accuracy in attention (pooled morbidity: 39.0%, 95%CI: 0.30-0.48) in neonates undergoing ECMO. The results of the Begg\'s test and sensitivity analysis indicated that the heterogeneity was originated from factors other than sample size.
CONCLUSIONS: This systematic
review and meta-analysis showed that neonates undergoing ECMO were associated with various neuropsychological complications. Additional randomized controlled trials (RCTs) with a larger sample size and a higher quality are needed.