USE OF EXTRACORPOREAL MEMBRANE-OXYGENATION IN THE SEPTIC NEONATE

Extracorporeal membrane oxygenation (ECMO) is widely used for cardiopu lmonary support in neonates with cardiopulmonary failure secondary to overwhelming sepsis. The purpose of this study was to examine the effe cts of culture status on the eventual outcome of septic neonates requi ring ECMO support. Data from the Extracorporeal Life Support Organizat ion (ELSO) for the years 1990 through 1992 inclusive were collected an d analyzed for all neonates with a primary diagnosis of sepsis. Record s were reviewed for gestational age, birth weight, culture status and isolated organism, last arterial blood gas before beginning ECMO, hemo rrhagic complications during bypass, and overall survival. Gram-positi ve sepsis accounted for 85% of positive cultures. Group B streptococcu s (GBS) and Escherichia coil were the most commonly isolated organisms (GBS: 95% of all gram-positive sepsis; E coli: 76% of all gram-negati ve sepsis) from culture-positive patients. Culture-negative patients w ere found to have a significantly lower mortality rate compared with c ulture positive patients (16.6% versus 26.9%, P < .001). The incidence of intracranial hemorrhage (ICH) was greater in culture-positive neon ates when compared with culture negative (27.6% versus 20.1%, P < .05) . There was no difference in the incidence of ICH or eventual outcome between gram-positive and gram-negative sepsis. The culture-positive, septic neonate who requires ECMO support appears to be at an increased risk for intracranial hemorrhage and death. Intracranial hemorrhage a ppears to be the primary factor affecting survival in these patients. The etiologic organism does not affect the incidence of ICH or outcome . Frequent head ultrasounds and strict control of coagulation paramete rs are recommended in this patient population. Copyright (C) 1995 by W .B. Saunders Company