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Reconsidering ECMO in Premature Neonates

K Taylor Wild1, Holly L Hedrick2,3,4, Natalie E Rintoul5,2,3

  • 1Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, wildk@email.chop.edu.

Fetal Diagnosis and Therapy
|September 2, 2020
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) can save neonates with severe respiratory or cardiac issues. Recent data suggests ECMO is viable for premature infants, challenging older inclusion criteria.

Area of Science:

  • Neonatal medicine
  • Pediatric critical care
  • Cardiopulmonary support

Background:

  • Extracorporeal membrane oxygenation (ECMO) is crucial for neonates with life-threatening respiratory or cardiac conditions unresponsive to standard treatments.
  • Historically, strict inclusion criteria (gestational age ≥34 weeks, birthweight >2 kg) were applied due to concerns about high mortality and morbidity in preterm and low birthweight infants.

Purpose of the Study:

  • To evaluate the evolving role and safety of ECMO in premature neonates.
  • To assess recent evidence suggesting improved outcomes in younger/smaller infants receiving ECMO.

Main Methods:

  • Review of recent publications on ECMO use in neonates.
  • Analysis of survival rates and morbidities, particularly intracranial hemorrhage, in premature infants (32-34 weeks gestational age).

Main Results:

  • Recent studies indicate improved survival rates among neonates between 32-34 weeks gestational age undergoing ECMO.
  • A decrease in intracranial hemorrhage complications has also been observed in this population.

Conclusions:

  • Current ECMO inclusion criteria, based on gestational age and birthweight, may be overly restrictive.
  • ECMO should be considered on an individual basis for premature neonates, with careful consideration of potential risks and benefits.

Keywords:
Congenital diaphragmatic herniaExtracorporeal membrane oxygenationPrematurity

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