Deterioration of exercise capacity after neonatal extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) provides life support in acute reversible cardio respiratory failure. Assessment of long-term morbidity is essential to confirm the survival advantage.

Objective of this study: to assess exercise capacity in the first 12 years of life after neonatal ECMO, and to evaluate the effect of primary diagnosis, lung function or perinatal characteristics on exercise capacity.

Patients and methods: 120 children who as neonates underwent ECMO performed 191 reliable exercise tests according to the Bruce treadmill protocol at age 5, 8 and/or 12 years between 2001 and 2010. Primary diagnoses: meconium aspiration syndrome (n=66); congenital diaphragmatic hernia (n=18); other diagnoses (n=36).

Results: At ages 5, 8 and 12 years, ANOVA resulted in mean (± SE) SDS endurance time on the treadmill of −0.5 (±0.1), −1.1 (±0.1), and −1.5 (±0.2), respectively, all significantly less than zero (p<0.001). Exercise capacity declined significantly over time irrespective of primary diagnosis.

Conclusion: neonates treated with ECMO are at risk for decreased exercise capacity at school age. We therefore propose prolonged follow-up. Pro-active advice on sports participation or referral to a physical therapist is recommended; especially when either the parents or the children themselves report impaired exercise capacity.