Emel OKULU, Saadet ARSAN, E. Bahar BİNGÖLER PEKCİCİ, Funda AKPINAR, Ezgi ÖZALP AKIN, Ömer ERDEVE, F. Begüm ATASA

Yenidoğan Döneminde Ekstrakorporeal Membran Oksijenasyonu (ECMO) Uygulanan Bebeklerin Gelişimsel Değerlendirilmesi: Tek Merkezden İlk Sonuçlar

Amaç: Yenidoğan döneminde Ekstrakorporeal Membran Oksijenasyonu (ECMO) desteği alan bebekler yaşam boyu gelişimsel sorunlar için risk taşımaktadır. Araştırmanın amacı Ankara Üniversitesi (AÜ) Yenidoğan Yoğun Bakım Ünitesinde ECMO desteği almış olan yenidoğanların gelişimsel risklerinin, 1 ve 2 yaş izlemlerindeki gelişimsel durumlarının belirlenmesidir. Gereç ve Yöntemler: Bu araştırmadaki bebekler, perinatal risk etmenleri ve yenidoğan yoğun bakım izlemi bilgileri, G-GİDR (Genişletilmiş Gelişimi İzleme ve Destekleme Rehberi), GİDR (Gelişimi İzleme ve Destekleme Rehberi) ve BSID-III (Bayley Bebeklik ve Erken Çocukluk Dönemi Gelişimi Değerlendirme Ölçeği) araçları kullanılarak değerlendirilmiştir. Bulgular: Ankara Üniversitesi Tıp Fakültesi Yenidoğan Yoğun Bakım Ünitesinde Eylül 2015-Eylül 2017 tarihleri arasında ECMO desteği alan 12 bebekten yaşamda kalan 8’i örneklemi oluşturmaktadır. Bir bebek Down sendromu tanılı olup, 1 ve 2 yaş izleminde, dil, bilişsel, ince ve kaba hareket gelişim alanlarında belirgin gelişimsel gecikmesi bulunmuştur, bir bebekte ise 2 yaş değerlendirmesinde ifade dili gelişiminde gecikme saptanmıştır. Sonuç: Ankara Üniversitesi Yenidoğan Yoğun Bakım Ünitesinde ECMO desteği almış bebeklerin dil, bilişsel ve hareket gelişimleri standart araçlarla değerlendirildiğinde %75’inin (6 olgu) gelişimi tüm alanlarda yaşıyla uyumlu bulunmuştur. Bu bebeklerin gelişimsel risklerinin saptanması, gelişimin ve ailenin desteklenmesi, erken tanı ve girişimlerin sağlanması amacıyla transdisipliner yaklaşım ile gelişimsel izlemleri önem taşımaktadır.

Anahtar Kelimeler:

ECMO, Gelişim, Gelişimsel zorluk

Developmental Evaluation of Infants Treated with ECMO during Their Newborn Period: Preliminary Results of a Single Center

Objective: The infants who received extracorporeal membrane oxygenation (ECMO) support in the neonatal period may have life-long developmental risks. The objective of this study was to determine the developmental risk factors and developmental status at the 1st and 2nd year follow-up evaluations of the infants who were supported with ECMO in the neonatal period at Ankara University (AU) Neonatal Intensive Care Unit (NICU). Material and Methods: Infants in this research were evaluated with the information of perinatal risk factors, neonatal intensive care unit progress and the evaluations with the Expanded-Guide for Monitoring Child Development (Exp- GMCD), Guide for Monitoring Child Development (GMCD), and the Bayley Scales of Infant Development-III (BSID-III). Results: The sample consisted of 8 babies who survived from 12 newborns who received ECMO support at AU NICU between September 2015 and September 2017. One of the babies with Down syndrome had significant developmental delays in the language, cognitive, fine and gross motor domains at 1st and 2nd year follow-up and another baby had an expressive language delay at the 2nd year evaluation. Conclusion: According to the developmental assessment of the infants who received ECMO support at the AU NICU, 75% (6 cases) were developed age-appropriately in all developmental domains with standardized tools. It is important to monitor the development of these children with a transdiciplinary approach to determine risk factors, support early childhood development and the family, and provide early diagnosis and intervention.

Keywords:

ECMO, Development, Developmental difficulty,

PDF

___

1.Mok YH, Lee JH, Cheifetz IM. Neonatal extracorporeal membrane oxygenation: Update on management strategies and long-term outcomes. Advances in Neonatal Care 2016;16:26–36.
2. Bartlett RH. Esperanza: Presidential address. Trans Am Soc Artif Intern Organs 1985;31:723-6.
3. The Extracorporeal Life Support Organization (ELSO). ECLS Registry Report, International Summary, January 2017. Ann Arbor, MI: Extracorporeal Life Support Organization; 2017.
4. Ijsselstijn H, van Heijst AF. Long-term outcome of children treated with neonatal extracorporeal membrane oxygenation: Increasing problems with increasing age. Semin Perinatol 2014;38:114-21.
5. Engle WA, West KW, Hocutt GA, Pallotto EK, Haney B, Keith RJ, et al. Adult outcomes after newborn respiratory failure treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med 2017;18:73-9.
6. Davis DW. Long-term follow-up of survivors of neonatal ECMO: What do we really know? Pediatr Nurs 1998;24:343-7.
7. Ahmad A, Gangitano E, Odell RM, Doran R, Durand M. Survival, intracranial lesions, and neurodevelopmental outcome in infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation. J Perinatol 1999;19(6 Pt 1):436-40.
8. Parish AP, Bunyapen C, Cohen MJ, Garrison T, Bhatia J. Seizures as a predictor of long-term neurodevelopmental outcome in survivors of neonatal extracorporeal membrane oxygenation (ECMO). J Child Neurol 2004;19:930-4.
9. Schiller RM, Madderom MJ, Reuser JJ, Steiner K, Gischler SJ, Tibboel D, et al. Neuropsychological follow-up after neonatal ECMO. Pediatrics 2016;138(5). pii: e20161313.
10. Madderom MJ, Reuser JJCM, Utens EM, van Rosmalen J, Raets M, Govaert P, et al. Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: A nationwide multicenter study. Intensive Care Med 2013;39:1584-93.
11. Gedik E, Atar F, Ozdemirkan A, Camkiran Firat A, Zeyneloglu P, Sezgin A, Pirat A. Perioperative venoarterial extracorporeal membrane oxygenation support during heart transplant. Exp Clin Transplant 2017;15:224-30.
12. Erek E, Aydın S, Suzan D, Yıldız O, Altın F, Kırat B, et al. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery. Anatol J Cardiol 2017;17:328-33.
13. Öztürk MN, Ak K, Erkek N, Yeşil E, Duyu M, Yazici P, et al. Early extracorporeal life support experiences in 2 tertiary pediatric intensive care units in Turkey. Turk J Med Sci 2014;44:769-74.
14. Okulu E, Atasay FB, Tunç G, Akduman H, Erdeve Ö, Arsan S, et al. Extracorporeal membrane oxygenation support in neonates: A single center experience in Turkey. Turk J Med Sci, in press. doi:10.3906/sag-1707-62.
15. Bronfenbrenner U. Ecological models of human development. In: International Encyclopedia of Education, Volume 3, 2nd ed. Oxford: Elsevier. Reprinted in: Gauvain, M & Cole M (eds) Readings on the development of children. 2nd ed. New York: Freeman, 1993:37- 43.
16. World Health Organization, The International Classification of Functioning, Disability and Health (ICF). Geneva: WHO, 2001.
17. Galip N. Gelişimi İzleme ve Destekleme Rehberi”nin “Dünya Sağlık Örgütü (DSÖ) İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırması (ICF-CY)” na Uyarlanması ve 0–5 Yaş Arası Kronik Hastalığı Olan Çocukların Değerlendirilmesinde Geçerliliği. Yayınlanmamış Uzmanlık Tezi, Ankara Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Ankara, Türkiye, 2009.
18. Ertem IO, Krishnamurthy V, Mulaudzi MC, Sguassero Y, Balta H, Gulumser O, et al. Similarities and differences in child development from birth to age 3 years by sex and across four countries: A crosssectional, observational study. Lancet Glob Health 2018;6:e279- 91.
19. Bayley N. Bayley Scales of Infant and Toddler Development: Administration Manual. 3rd ed. San Antonio: Psychological Corporation, 2006.
20. SPSS (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.
21. Bernbaum J, Schwartz IP, Gerdes M, D’Agostino JA, Coburn CE, Polin RA. Survivors of extra corporeal membrane oxygenation at 1 year of age: The relationship of primary diagnosis with health and neurodevelopmental sequelae. Pediatrics. 1995;96:907–13.
22. Robertson CM, Finer NN, Sauve RS, Whitfield MF, Belgaumkar TK, Synnes AR, et al. Neurodevelopmental outcome after neonatal extracorporeal membrane oxygenation. CMAJ 1995;152:1981-8.
23. The collaborative UKECMO (Extracorporeal Membrane Oxygenation) trial: Follow-up to 1 year of age. Pediatrics 1998;101:E1.
24. Macrae DJ, Field DJ. Our study 20 years on: UK Collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Intensive Care Med 2016;42:841-3 . 25. Khambekar K, Nichani S, Luyt DK, Peek G, Firmin RK, Field DJ, et al. Developmental outcome in newborn infants treated for acute respiratory failure with extra corporeal membrane oxygenation: Present experience. Arch Dis Child Fetal Neonatal Ed 2006;91:F21– 5.
26. Flamant C, Lorino E, Nolent P, Hallalel F, Chevalier JY, Fau S, et al. Newborn infants supported by extracorporeal membrane oxygenation: Survival and clinical outcome. Arch Pediatr 2007;14:354-61.
27. Bennett CC, Johnson A, Field DJ, Elbourne D, Group UKCET U.K. Collaborative randomised trial of neonatal extracorporeal membrane oxygenation: Follow-up to age 4 years. Lancet 2001;357:1094–6.
28. Wien MA, Whitehead MT, Bulas D, Ridore M, Melbourne L, Oldenburg G, et al. Patterns of brain ınjury in newborns treated with extracorporeal membrane oxygenation. AJNR Am J Neuroradiol 2017;38:820-6.
29. Cashen K, Thiagarajan RR, Collins JW Jr, Rycus PT, Backer CL, Reynolds M, et al. Extracorporeal membrane oxygenation in pediatric trisomy 21: 30 years of experience from the extracorporeal life support organization registry. J Pediatr 2015;167:403-8.