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Updated: Nov 12, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
The association of inborn status and resource utilization among neonates who received extracorporeal membrane
Kathryn L Fletcher1, Vilma Contreras2, Ashley Song2
1Department of Pediatrics, Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
Insights
Inborn neonates receiving extracorporeal membrane oxygenation (ECMO) had longer hospital stays, higher costs, and increased mortality compared to outborn neonates. These findings suggest inborn infants represent a higher-risk population requiring further study for optimal care.
Area of Science:
- Neonatal care
- Pediatric critical care
- Medical economics
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for neonates with severe cardiorespiratory failure.
- While ECMO's cost-effectiveness is established in some groups, factors influencing length of stay (LOS) and total hospital costs remain unclear.
- This study compares resource utilization and outcomes for inborn versus outborn neonates undergoing ECMO.
Purpose of the Study:
- To determine if inborn neonates receiving ECMO have different resource utilization and outcomes compared to outborn neonates.
- To identify factors associated with LOS, total hospital costs, and mortality in these two distinct neonatal populations.
- To inform decisions regarding the optimal site of delivery for neonates requiring ECMO.
Main Methods:
- Retrospective cohort study utilizing the Healthcare Cost and Utilization Project's Kids' Inpatient Database (1997-2012).
- Categorization of neonates (<28 days) into inborn and outborn groups based on ECMO initiation location.
- Multivariable analysis to assess factors associated with LOS, total hospital costs, and mortality.
Main Results:
- Analysis of 5,152 neonates (800 inborn, 4,352 outborn) receiving ECMO.
- Inborn neonates showed a higher prevalence of cardiac-related diagnoses (70.5% vs. 62.1%).
- Adjusted analysis revealed inborn neonates had significantly longer LOS (13.2 days), higher costs ($62,000), and increased mortality (OR 2.4) compared to outborn neonates.
Conclusions:
- Inborn neonates undergoing ECMO present with more complex conditions, including cardiac diseases and congenital diaphragmatic hernia.
- These infants experience longer hospital stays, incur higher total costs, and face greater mortality risks than their outborn counterparts.
- The inherent differences between inborn and outborn neonates undergoing ECMO warrant further investigation to optimize delivery site selection and management strategies.
Background:
Many studies have established that extracorporeal membrane oxygenation (ECMO) can be a cost-effective treatment in some populations, but limited data exist on which factors are associated with length of stay (LOS) and total hospital costs. This study aimed to determine if inborn (i.e., cared for in their birth hospitals) neonates who receive ECMO have different resource utilization and outcomes compared to outborn (i.e., not cared for in their birth hospitals) neonates who receive ECMO.
Methods:
A retrospective cohort study was conducted using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 1997-2012. Neonates (infants, <28 days) placed on ECMO were categorized as either inborn or outborn. Salient clinical characteristics were compared between groups. A multivariable analysis was performed to identify the factors associated with length of stay (LOS), total hospital costs, and mortality in these two patient populations.
Results:
Of 5,152 neonates receiving ECMO, 800 were inborn and 4,352 were outborn. Inborn neonates were more frequently diagnosed with cardiac-related diagnoses (70.5% vs 62.1%, p < 0.001). After adjusting for demographics and hospital-level factors, inborn neonates had longer hospital LOS (13.2 days, 95% CI, 8.7-18.7; p < 0.001), higher total encounter costs ($62,000, 95% CI, 40,000-85,000; p < 0.001) and higher mortality (OR 2.4, 95% CI 1.9-2.9; p < 0.001) compared to outborn neonates.
Conclusions:
Inborn neonates placed on ECMO were more frequently diagnosed with cardiac-related diseases or congenital diaphragmatic hernia, had longer LOS, higher total encounter costs, and higher mortality rates relative to their outborn counterparts, and likely represent a higher risk population. These two populations of infants may be inherently different and their differences should be further explored to inform decision making about optimal site of delivery.
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