Developmental outcome of infants treated with extracorporeal membrane oxygenation (ECMO) in the neonatal period: is the evidence all in?

The North American literature was reviewed regarding the developmental outcome of infants treated with ECMO therapy versus those infants who received conventional medical therapy for treatment of persistent pulmonary hypertension of the newborn. The literature reviewed included all ECMO follow-up investigations published in medical journals cited in CD-ROM between January 1980 and July 1992, as well as abstracts presented at the Society for Pediatric Research 1990-1992. The literature was examined with respect to the incidence, prevalence and nature of morbidity, with particular attention paid to the neuroevelopmental domains assessed, test measures used, age at assessment and criteria for normal and abnormal outcome. Rough comparison of the published outcome statistics for the cohorts of infants who received neonatal ECMO therapy or conventional medical therapy (CMT) suggest equivalent amounts of morbidity within the first few years of life. Without appropriate systematic comparison at the same ages on the same measures and in infants with equivalent severity of illness, the current observations remain tentative at best. Longitudinal investigations are needed in order to identify specific medical and developmental markers in infancy of good and poor long-term outcome in this population, together with comparisons of outcome in the group treated with ECMO versus the group treated with CMT. Fine-grained, sensitive measures must be employed that record transient or permanent delays and/or qualitative deficits in specific skills.