Two years' follow-up of newborn infants after extracorporeal membrane oxygenation (ECMO)

Objective: Extracorporeal membrane oxygenation (ECMO) is a technique of ext racorporeal oxygenation used in newborn infants with refractory hypoxemia a fter failure of maximal conventional medical management. when mortality ris k is higher than 80%. We retrospectively reviewed all the neonates treated by ECMO between October 1991 and September 1997 in our newborn intensive ca re unit. Methods: Fifty-seven patients were treated with ECMO for severe re spiratory failure: congenital diaphragmatic hernia (CDH) (n = 23), neonatal sepsis (NS) (n = 14), meconium aspiration syndrome (MAS) (n = 12), and oth ers (n = 8). Mean gestational age and birth weight were 38 +/- 2 weeks and 3200 +/- 500 g, respectively. Oxygenation index was 61 +/- 8. Both venoveno us (n = 213) or venoarterial ECMO (n = 29) were used. The mean time at ECMO initiation was 47 h (range 8 h-2 months). The mean duration was 134 +/- 68 h. In each case of VA ECMO, carotid reconstruction was performed. Survival at 2 years was 40/57 (70%) (CDH 12/23 (52%), NS 11/14 (79%), MAS 12/12 (10 0%), others 5/8). Follow-up at 2 years was available in 36 survivors. Resul ts: Neurodevelopmental outcome was not related to the initial diagnosis: no rmal neurologic development (n = 30), cerebral palsy (n = 5), and neurologi c developmental delay (n = 1). Two patients remained oxygen dependant at 2 years, and four required surgical treatment for severe gastroesophageal ref lux. Respiratory and digestive sequelae were more frequent in the CDH group (P < 0.01). Patency and flow of the repaired carotid artery was assessed i n 20 infants at 1 year of age using Doppler ultrasonography: normal (n = 10 ), < 50% stenosis (n = 9), and > 50% stenosis (n = 1). Conclusion: ECMO inc reased survival of newborn infants with refractory hypoxemia. However, high er a survival rate and lower morbidity were found in non-CDH infants than i n congenital diaphragmatic hernia. (C) 2000 Elsevier Science B.V. All right s reserved.