Abstract 1434 Neurodevelopmental Disabilities Poster Symposium, Tuesday, 5/4

Infants treated with ECMO are at risk for neurodevelopmental abnormalities secondary to their serious neonatal illness as well as the thrombotic and hemorrhagic risks of the ECMO procedure. Follow-up studies of these extremely high risk infants in the early years of life have concentrated mainly on the incidence of major cognitive (mental retardation) and motor disabilities (cerebral palsy). We report the results of a part of our follow-up protocol that involves a more detailed assessment of motor skills in both gross and fine motor areas using the Bayley Scales of Infant Development (BSID) and the Peabody Infant Motor Scales (Peabody).

Between 1990 and 1995, 125 infants survived after being treated with ECMO for respiratory failure at Duke. Ninety-nine infants were recruited into our follow-up study of which 76 (77%) were evaluated at 1 year of age, and 72 (73%) were examined at 2 years of age. Twenty-three infants (32%) manifested significant abnormalities of muscle tone and movement on their neurologic exam. Motor scores on the BSID are recorded as the PDI (Psychomotor Developmental Index) and scores on the Peabody as DMQ (Developmental Motor Quotient; GM (Gross Motor) or FM (Fine Motor)). All scores are based on a mean=100± SD=15.

Overall motor functioning (PDI) is significantly lower at 2 years of age than at 1 year (90.0±21.4 versus 82.4±19.8, p=.002) When motor skills are divided into gross and fine motor categories using the Peabody Scales, there is no difference in the mean gross motor DMQ from 1 to 2 years of age (83.4±18.0 versus 82.7±22.5). However, there is a significant decrease in fine motor scores by 2 years of age (81.9±11.5 versus 71.0±17.4, p=.0005). There is no obvious discrepancy between gross and fine motor skills at 1 years (83.4±18.0 versus 81.9±11.5), but there is a marked difference in the two types of motor performance at 2 years of age (82.7±22.5 versus 71.0±17.4, p=.0001). The number of children with gross motor scores below 2 standard deviations actually decreases between 1 and 2 years of age (from 36 to 19%), while the number with fine motor skill scores below 2 standard deviations more than doubles (from 21 to 46%).

The results of this study indicate an extremely high incidence of fine motor delays in infants treated with ECMO in the newborn period. These delays are more evident on testing at two years of age with an incidence of almost 50%. The data support the importance of careful fine motor evaluations in this group of children in the preschool years so that intervention may be initiated that will enhance school readiness as well as identify children at risk for later learning disabilities.