SEVERE RESPIRATORY-FAILURE IN NEONATES - MORTALITY AND MORBIDITY RATES AND NEURODEVELOPMENTAL OUTCOMES

Objective: To compare the survival, neurodevelopmental, and health out comes of children with severe respiratory illness treated with and wit hout extracorporeal membrane oxygenation (ECMO). Design: Prospective c ollection of clinical and demographic data of all neonates reaching il lness severity criteria, with follow-up at 8 and 20 months of age. Pat ients were assigned to treatment by the attending physician. Patients: Consecutive sample of 74 neonates during a 24-month period with an al veolar-to-arterial gradient exceeding 620 for 8 or more hours. Results : Eighteen (69%) of 26 neonates treated with conventional therapy surv ived to 20 months, in comparison with 43 (90%) of 48 neonates treated with ECMO. The conventionally treated group had significantly more chr onic lung disease, longer duration of oxygen therapy, more chronic rea ctive airway disease, and more rehospitalizations than those treated w ith ECMO. Hospital charges were similar in the two groups. Macrocephal y was noted in 24% of those treated with ECMO and in none of the conve ntional group. Of those completing evaluation, 4 (24%) of 17 conventio nally treated survivors and 20 (26%) of 38 ECMO-treated survivors had neurodevelopmental impairment. Conclusion: Survivors of severe neonata l respiratory illness have significant pulmonary and neurodevelopmenta l impairment, regardless of the treatment used. Neonates treated with ECMO had neurodevelopmental outcomes similar to those of patients trea ted conventionally, but better pulmonary outcomes.