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A 20-year experience on neonatal extracorporeal membrane oxygenation in a referral center

T. Schaible| D. Hermle| F. Loersch| S. Demirakca| K. Reinshagen| V. Varnholt
Pediatric Original
Volume 36, Issue 7 / July , 2010

Pages 1229 - 1234

Abstract

Objective

Advances in treatment of neonatal respiratory failure are responsible for a decline in the number of newborns treated with extracorporeal membrane oxygenation (ECMO). The aim of this study are to determine demographic changes, focusing on time of referral, diagnosis, and respiratory parameters in neonates put on ECMO.

Design

Retrospective review.

Setting

Tertiary ECMO center.

Patients

A total of 321 neonates were treated with ECMO from January 1987 to December 2006.

Results

Overall number of patients increased with every 5-year period, whereby congenital diaphragmatic hernia (CDH) was the most common diagnosis (53%), followed by meconium aspiration syndrome (MAS) (21%), sepsis and/or pneumonia (13%), and others such as persistent pulmonary hypertension of the newborn (PPHN), respiratory distress syndrome (RDS), or hypoplasia of the lung (13%). Worsening severity of illness as measured by ECMO duration and days on ventilator has to be stated for all diagnoses. Nevertheless, survival rate remained stable; both overall and diagnosis-specific mortality rates did not change significantly. Of all children, 67% survived to discharge or transfer, while best rates were seen for MAS (94%), followed by sepsis and/or pneumonia (69%), CDH (62%), and other diagnoses (43%). Concerning survival rate, no difference between inborn and outborn children occurred. However, between early- and late-referred children, a referral to the ECMO center during the first 24 h of life was associated with a significantly higher rate of survival (77% versus 54%, p = 0.0004), predominantly seen for CDH (67% versus 35%, p = 0.02).

Conclusion

We strongly recommend timely transfer to an ECMO center in patients with CDH who are at risk of circulatory failure.

Keywords

References

  1. UK Collaborative ECMO Trial Group (1996) UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet 348:75–82
    • View reference on publisher's website
  2. Elbourne D, Field D, Mugford M (2002) Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev, CD001340
  3. Bartlett RH (1985) Esperanza: presidential address. Trans Am Soc Artif Intern Organs 31:723–726
    • View reference on PubMed
  4. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW (1976) Extracorporeal membrane oxygenation (ECMO): cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 22:80–93
    • View reference on PubMed
  5. ECMO Registry of the Extracorporeal Life Support Organization (ELSO) (2006) Ann Arbor, Michigan
  6. Rais-Bahrami K, Van Meurs KP (2005) ECMO for neonatal respiratory failure. Semin Perinatol 29:15–23
    • View reference on publisher's website
  7. El Shahed AI, Dargaville P, Ohlsson A, Soll RF (2007) Surfactant for meconium aspiration syndrome in full term/near term infants. Cochrane Database Syst Rev, CD002054
  8. Finer NN, Barrington KJ (2006) Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev, CD000399
  9. Fliman PJ, deRegnier RA, Kinsella JP, Reynolds M, Rankin LL, Steinhorn RH (2006) Neonatal extracorporeal life support: impact of new therapies on survival. J Pediatr 148:595–599
    • View reference on publisher's website
    • View reference on PubMed
  10. Hintz SR, Suttner DM, Sheehan AM, Rhine WD, Van Meurs KP (2000) Decreased use of neonatal extracorporeal membrane oxygenation (ECMO): how new treatment modalities have affected ECMO utilization. Pediatrics 106:1339–1343
    • View reference on publisher's website
    • View reference on PubMed
  11. Kössel H, Bauer K, Kewitz G, Karaca S, Versmold H (2000) Do we need new indications for ECMO in neonates pretreated with high-frequency ventilation and/or inhaled nitric oxide? Intensive Care Med 26:1489–1495
  12. Conrad SA, Rycus PT, Dalton H (2005) extracorporeal life support registry report 2004. ASAIO J 51:4–10
  13. Roy BJ, Rycus P, Conrad SA, Clark RH (2000) The changing demographics of neonatal extracorporeal membrane oxygenation patients reported to the Extracorporeal Life Support Organization (ELSO) Registry. Pediatrics 106:1334–1338
    • View reference on publisher's website
    • View reference on PubMed
  14. Lotze A, Mitchell BR, Bulas DI, Zola EM, Shalwitz RA, Gunkel JH, Survanta in Term Infants Study Group (1998) Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure. J Pediatr 132:40–47
    • View reference on publisher's website
    • View reference on PubMed
  15. Soll RF (1998) Synthetic surfactant for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev, CD001149
  16. Bhuta T, Clark RH, Henderson-Smart DJ (2001) Rescue high frequency oscillatory ventilation vs conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst Rev, CD002974
  17. The Neonatal Inhaled Nitric Oxide Study Group (1997) Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med 336:597–604
    • View reference on publisher's website
  18. The Neonatal Inhaled Nitric Oxide Study Group (NINOS) (1997) Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragma hernia. Pediatrics 99:838–845
    • View reference on publisher's website
  19. Roberts JD, Fineman JR, Morin FC, Shaul PW, Rimar S, Schreiber MD, Polin RA, Zwass MS, Zayek MM, Gross I, Heymann MA, Zapol WM, The Inhaled Nitric Oxide Study Group (1997) Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. N Engl J Med 336:605–610
    • View reference on publisher's website
    • View reference on PubMed
  20. Clark RH, Kueser TJ, Walker MW, Southgate WM, Huckaby JL, Perez JA, Roy BJ, Keszler M, Kinsella JP, Clinical Inhaled Nitric Oxide Research Group (2000) Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. N Engl J Med 342:469–474
    • View reference on publisher's website
    • View reference on PubMed
  21. Farrow KN, Fliman P, Steinhorn RH (2005) The diseases treated with ECMO: focus on PPHN. Semin Perinatol 29:8–14
    • View reference on publisher's website
    • View reference on PubMed
  22. Cogo PE, Zimmermann LJ, Rosso F, Tormena F, Gamba P, Verlato G, Baritussio A, Carnielli VP (2002) Surfactant synthesis and kinetics in infants with congenital diaphragmatic hernia. Am J Respir Crit Care Med 166:154–158
    • View reference on publisher's website
    • View reference on PubMed
  23. Mohseni-Bod H, Bohn D (2007) Pulmonary hypertension in congenital diaphragmatic hernia. Semin Pediatr Surg 16:126–133
    • View reference on publisher's website
    • View reference on PubMed
  24. Ostrea EM, Villanueva-Uy ET, Natarajan G, Uy HG (2006) Persistent pulmonary hypertension of the newborn: pathogenesis, etiology, and management. Pediatr Drugs 8:179–188
    • View reference on publisher's website
  25. Walsh MC, Stork EK (2001) Persistent pulmonary hypertension of the newborn: rational therapy based on pathophysiology. Clin Perinatol 28:609–627
    • View reference on publisher's website
    • View reference on PubMed
  26. Van Meurs K, Congenital Diaphragmatic Hernia Study Group (2004) Is surfactant therapy beneficial in the treatment of the term newborn infant with congenital diaphragmatic hernia? J Pediatr 145:312–316
    • View reference on publisher's website
    • View reference on PubMed
  27. Wung JT, James LS, Kilchevsky E, James E (1985) Management of infants with severe respiratory failure and persistance of the fetal circulation, without hyperventilation. Pediatrics 76:488–494
    • View reference on PubMed
  28. Gill BS, Neville HL, Khan AM, Cox CS, Lally KP (2002) Delayed institution of extracorporeal membrane oxygenation is associated with increased mortality rate and prolonged hospital stay. J Pediatr Surg 37:7–10
    • View reference on publisher's website
    • View reference on PubMed
  29. Hui TT, Danielson PD, Anderson KD, Stein JE (2002) The impact of changing neonatal respiratory management on extracorporeal membrane oxygenation utilization. J Pediatr Surg 37:703–705
    • View reference on publisher's website
    • View reference on PubMed
  30. Kennaugh JM, Kinsella JP, Abman SH, Hernandez JA, Moreland SG, Rosenberg AA (1997) Impact of new treatments for neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. J Perinatol 17:366–369
    • View reference on PubMed
  31. Kugelman A, Gangitano E, Taschuk R, Garza R, Riskin A, McEvoy C, Durand M (2005) Extracorporeal membrane oxygenation in infants with meconium aspiration syndrome: a decade of experience with venovenous ECMO. J Pediatr Surg 40:1082–1089
    • View reference on publisher's website
    • View reference on PubMed
  32. Buesing KA, Kilian AK, Schaible T, Dinter DJ, Neff KW (2008) MR lung volume in fetal congenital diaphragmatic hernia: logistic regression analysis mortality and extracorporeal membrane oxygenation. Radiology 248:233–239
    • View reference on publisher's website
  33. Logan JW, Rice HE, Goldberg RN, Cotton CM (2007) Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies. J Perinatol 27:535–549
    • View reference on publisher's website
    • View reference on PubMed
  34. Boedy RF, Howell CG, Kanto WP (1990) Hidden mortality rate associated with extracorporeal membrane oxygenation. J Pediatr 117:462–464
    • View reference on publisher's website
    • View reference on PubMed

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