Alterations and prognosis of postoperative ECMO support on neurodevelopment in neonatal patients with complex congenital heart disease
10.3760/cma.j.cn115354-20250708-00396
- VernacularTitle:复杂性先天性心脏病患儿术后ECMO支持下神经发育的改变及转归
- Author:
Yueyue ZHANG
1
;
Xi CHEN
;
Zhuoming XU
;
Lin CHEN
;
Nan BAO
;
Yinyu YANG
Author Information
1. 上海交通大学医学院附属上海儿童医学中心心胸外科，上海 200127
- Publication Type:Journal Article
- Keywords:
Neurodevelopment;
Nervous system injury;
Neonate;
Congenital heart disease;
Extracorporeal membrane oxygenation;
Systematic neurorehabilitation
- From:
Chinese Journal of Neuromedicine
2025;24(9):909-914
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the impact of postoperative extracorporeal membrane oxygenation (ECMO) support on neurodevelopment of neonatal patients with complex congenital heart disease (CHD) and its early neurorehabilitation intervention effect.Methods:A retrospective analysis was performed; 17 neonates who underwent complex CHD corrective surgery with ECMO support in Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University from January 1, 2019 to December 31, 2021 were chosen. Neurological injury of the neonates was observed during ECMO support period. At 12 months old, the neonates underwent head MRI; and Griffiths Developmental Scale-Chinese version (GDS-C) were performed on the neonates to evaluate the neurodevelopment. A systematic neurorehabilitation intervention program was implemented for neonates with abnormal neurodevelopment as indicated by GDS-C, and GDS-C was performed again to assess the neurodevelopmental changes of the neonates at 36 months old.Results:(1) During ECMO support period, 13 neonates (76.47%) suffered from neurological damage, including 8 with simple intracranial hemorrhage, 2 with intracranial hemorrhage combined with ischemic hypoxic changes, 1 with intracranial hemorrhage combined with white matter injury, and 2 with white matter injury. (2) At 12 months old, head MRI revealed hemorrhagic foci or softening foci in 2 neonates; GDS-C indicated 12 neonates with delayed neurodevelopment, 4 with borderline status, and only 1 with normal development. (3) Among the 16 neonates with abnormal neurodevelopment who received systematic neurorehabilitation, 11 achieved normal neurodevelopment, 4 remained borderline, and 1 still had delayed development at 36 months old indicated by GDS-C. Compared with those before the neurorehabilitation intervention, the neonates after neuro-rehabilitation intervention had better neurodevelopmental rating (average ranks: 9.630 and 23.380, respectively), and significantly improved neurodevelopmental quotients in the 4 major dimensions of motor, personal-social, language, and hand-eye coordination ( P<0.05). Conclusion:Neonates accepted CHD surgery face high risks of postoperative neurological complications during ECMO support period; incidence of neurodevelopmental abnormalities is high in neonates at 12 months old; by implementing a systematic neurorehabilitation intervention, the outcomes of neonates with neurodevelopmental abnormalities can be effectively improved.
