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Published on: October 11, 2011
Predicting outcome in ex-premature infants supported with extracorporeal membrane oxygenation for acute hypoxic
K L Brown1, G Walker, D J Grant
1Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Extracorporeal membrane oxygenation (ECMO) offers favorable survival for ex-premature infants with respiratory failure. However, long-term neurodisability and pulmonary issues are common, with oxygen dependence predicting mortality.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Respiratory Medicine
Background:
- Ex-premature infants with acute hypoxic respiratory failure often require advanced support.
- Extracorporeal membrane oxygenation (ECMO) is a critical intervention for severe respiratory failure in neonates and infants.
- Predicting outcomes in this vulnerable population is crucial for clinical decision-making.
Purpose of the Study:
- To identify predictors of survival and long-term morbidity in ex-premature infants undergoing ECMO for acute hypoxic respiratory failure.
- To analyze factors associated with mortality and neurodevelopmental outcomes post-ECMO.
- To evaluate the effectiveness of ECMO in this specific patient group.
Main Methods:
- Retrospective review of ex-premature infants receiving ECMO for acute hypoxic respiratory failure in the UK (1992-2001).
- Analysis of clinical data including birth gestation, corrected age at ECMO, and ECMO support duration.
- Review of follow-up data from general practitioners and pediatricians regarding patient outcomes and complications.
Main Results:
- Sixty-four ex-premature infants received ECMO, with respiratory syncytial virus being the most common pathogen.
- Survival to discharge and 6 months was 80%, with no significant change over the decade.
- Long-term follow-up revealed significant morbidity: 60% had neurodisability, and 79% had chronic pulmonary problems.
- Baseline oxygen dependence, younger age, and inpatient status predicted non-survival.
- ECMO-related patient complications were independently associated with adverse neurodevelopmental outcomes and death.
Conclusions:
- ECMO provides favorable survival rates for ex-premature infants with acute hypoxic respiratory failure.
- Despite good survival, a high burden of short-term and long-term morbidity exists.
- Baseline oxygen dependence at ECMO referral is the primary predictor of mortality.
- No single factor analyzed precluded ECMO support, suggesting its continued utility in selected cases.
Objective:
To identify predictors of outcome in ex-premature infants supported with extracorporeal membrane oxygenation (ECMO) for acute hypoxic respiratory failure.
Methods:
Retrospective review of ex-premature infants with acquired acute hypoxic respiratory failure requiring ECMO support in the United Kingdom from 1992 to 2001. Review of follow up questionnaires completed by general practitioners and local paediatricians.
Results:
Sixty four ex-premature infants (5-10 each year) received ECMO support, despite increased use of advanced conventional treatments over the decade. The most common infective agent was respiratory syncytial virus (85% of cases). Median birth gestation was 29 weeks and median corrected age at the time of ECMO support was 42 weeks. Median ECMO support duration was relatively long, at 229 hours. Survival to hospital discharge and to 6 months was 80%, remaining similar throughout the period of review. At follow up, 60% had long term neurodisability and 79% had chronic pulmonary problems. Of pre-ECMO factors, baseline oxygen dependence, younger age, and inpatient status were associated with non-survival (p < or = 0.05). Of ECMO related factors, patient complications were independently associated with adverse neurodevelopmental outcome and death (p < 0.01).
Conclusions:
Survival rates for ex-premature infants after ECMO support are favourable, but patients suffer a high burden of morbidity during intensive care and over the long term. At the time of ECMO referral, baseline oxygen dependence is the most important predictor of death, but no combination of the factors considered was associated with a mortality that would preclude ECMO support.
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