Reactive airway disease (RAD) is a known sequellae in newborn infants treated with ECMO for respiratory failure. Infants may manifest clinical evidence of RAD or may be found to have a beneficial response to bronchodilators (BD) by pulmonary function testing prior to hospital discharge. The development of RAD during the first 6 months of life in infants treated with ECMO has not been studied. As part of our ECMO follow-up study, crying vital capacities (CVC) were performed at the first follow-up visit on infants without known chronic lung disease (CLD).
Between March 1992 and August 1995, 94 infants survived treatment with ECMO at Duke of which 76 (81%) returned to our Special Infant Care Clinic at 3-4 months of age. 26 infants were being followed in the Pediatric Pulmonary Clinic for known CLD (persistent oxygen requirement or symptomatic RAD). Of the remaining 50 infants, 49 were evaluated by CVC measured as the largest inspiratory or expiratory breath during maximal crying. 14/49 (29%) had a CVC<95% predicted for size and 9/49 (18%) had a CVC ≤ 90% predicted. Of these, only 3/14 (20%) had symptoms of mild RAD by history and 13/14 (93%) had never been treated with BD therapy. When given a BD treatment (0.5 cc albuterol by nebulizer), all infants with CVC <95% improved by 13-50%. 9/14 of these infants (64%) developed clinically significant RAD requiring BD therapy by 6 -8 months of age resulting in an overall 50% incidence of RAD in this group of infants after ECMO treatment.
