Neurodevelopmental status at age five years of neonates treated with extracorporeal membrane oxygenation.

OBJECTIVE: To determine the neurodevelopmental status at age 5 years among children who received extracorporeal membrane oxygenation (ECMO) in the newborn period as a treatment for severe cardiorespiratory failure. METHODS: We conducted a prospective cohort study of 103 five-year-old ECMO-treated children born between June 1984 and July 1988, and treated at our institution. Thirty-seven healthy control children were recruited locally. The assessment protocol included a complete neuropsychologic assessment, psychosocial assessment with parent questionnaires, a standard neurologic evaluation, assessment of gross motor and fine motor function, a medical history, and physical examination. RESULTS: Major disability was present in 17 of the ECMO cohort. Eleven ECMO-treated children (11%) were mentally retarded, one of whom was profoundly impaired. Two additional children had severe learning disabilities. Cerebral palsy was diagnosed in 5 (5%) ECMO-treated children, but all cases were mild in nature and the patients were walking unaided. One child has paraplegia. The mean Full Scale, Verbal, and Performance IQs of the EMCO-treated children were within the normal range, but as a group were significantly lower than in control children (96 vs 115, p < 0.001). Children treated with ECMO had increased risk relative to the control children for academic difficulties at school age (49% VS 22%, P < 0.01) and a higher rate of behavioral problems reported by parents (42% vs 16%, p = 0.01). CONCLUSIONS: The rate of major disability was comparable to that in other high-risk populations. The high rate of behavioral problems and increased risk of subsequent school failure among nonretarded ECMO-treated children supports the need for close follow-up of these children after hospital discharge.

Cost, resource utilization, and severity of illness in intensive care.

The relationship between health care resource use and severity of illness is important to hospitals providing care to sicker patients, so we investigated the relationship between resource utilization, cost, and severity of illness in 229 consecutive patients admitted to a pediatric intensive care unit. Resources measured included length of stay and number and cost of laboratory and imaging studies. Pediatric intensive care unit and daily mortality risks (assessed by the Physiologic Stability Index and the Dynamic Risk Index) were stratified as very low risk (less than 1%), low risk (1% to 2.5%), moderate risk (2.5% to 5.0%), and high risk (greater than 5%). Increasing daily resource use was directly related to increasing gradations of severity of illness. For very low, low-, moderate-, and high-risk patient days, the daily numbers of diagnostic studies were (mean +/- SEM) 20.1 +/- 0.6, 31.4 +/- 1.1, 37.7 +/- 1.6, and 43.0 +/- 1.8, respectively. Total resource use, including diagnostic tests and length of stay, also increased with pediatric intensive care unit mortality risk. Diagnostic testing and corresponding costs were significantly higher for infants who died in the pediatric intensive care unit than for survivors on a day-by-day basis as well as for the entire stay in the care unit. We conclude that there is a direct, positive relationship between resource use, cost, and gradations of severity of illness that, if accounted for, would result in more equitable health care reimbursement.