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[Newborn infants supported by extracorporeal membrane oxygenation: survival and clinical outcome]

C Flamant1, E Lorino, P Nolent

  • 1Service de réanimation néonatale et pédiatrique, Assistance publique-Hôpitaux de Paris, hôpital d'enfants Armand-Trousseau, 26 avenue du Docteur-A.-Netter, 75571 Paris cedex 12, France. cyril.flamant@trs.aphp.fr

Archives De Pediatrie : Organe Officiel De La Societe Francaise De Pediatrie
|February 20, 2007
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) offers a favorable prognosis for newborns with severe respiratory failure, with low long-term morbidity despite initial challenges. Long-term outcomes for congenital diaphragmatic hernia (CDH) infants are generally positive.

Area of Science:

  • Neonatal Intensive Care
  • Pediatric Critical Care Medicine
  • Cardiopulmonary Support

Background:

  • Refractory hypoxemia in newborns presents a significant clinical challenge, often necessitating advanced life support.
  • Extracorporeal membrane oxygenation (ECMO) provides a critical intervention for neonates with severe respiratory or cardiac failure.
  • Understanding the long-term prognosis of infants treated with ECMO is essential for guiding clinical management and parental counseling.

Purpose of the Study:

  • To evaluate the long-term prognosis of newborn infants experiencing refractory hypoxemia who required extracorporeal membrane oxygenation (ECMO).
  • To identify factors influencing survival and morbidity in this high-risk neonatal population.
  • To specifically assess outcomes for infants with congenital diaphragmatic hernia (CDH) compared to other diagnoses.

Main Methods:

  • An observational cohort study included 89 newborn infants requiring ECMO for over 24 hours between 1996 and 2003.
  • Infants were followed up at 9 months and 24 months post-treatment.
  • Data collected included primary diagnosis, duration of ECMO, survival rates, oxygen dependency, feeding status, and neurodevelopmental outcomes.

Main Results:

  • Overall survival to hospital discharge was 67%. Meconium aspiration syndrome (MAS) had the highest survival rate (82%), while congenital diaphragmatic hernia (CDH) had the lowest (46%).
  • Among survivors, oxygen dependency decreased significantly over time, with only one infant requiring oxygen at 2 years.
  • CDH infants experienced prolonged oxygen and tube feeding durations, and initially poorer neurological acquisition, but showed favorable neurodevelopmental evolution by 24 months.

Conclusions:

  • Morbidity in ECMO survivors is relatively low given the severity of their initial illness, with pulmonary and feeding issues being the primary concerns in the early months.
  • The long-term prognosis for infants with CDH treated with ECMO is generally favorable regarding growth and neurodevelopmental outcomes by age two.
  • ECMO is an effective therapy for severe neonatal respiratory failure, offering a positive outlook for most survivors, particularly those with MAS.
Abstract

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