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Impact of in utero drug exposure on neonates requiring ECMO: A retrospective cohort study
Hallie Walther1, Aric Schadler2, Karen Garlitz2,3
1College of Medicine, University of Kentucky, Lexington, KY, United States.
Insights
Neonates exposed to drugs in utero (IUDE) requiring extracorporeal membrane oxygenation (ECMO) needed more sedatives and had longer hospital stays, but survival was similar to those without IUDE.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Critical Care Medicine
Background:
- The incidence of in utero drug exposure (IUDE) and neonatal extracorporeal membrane oxygenation (ECMO) utilization have both increased.
- No prior studies have examined the impact of IUDE on neonates requiring ECMO.
Purpose of the Study:
- To compare the clinical course and outcomes of neonates on ECMO with and without IUDE.
- To identify potential differences in medication use, complications, and hospital stay between these groups.
Main Methods:
- Retrospective cohort study.
- Analysis of medical records for neonatal ECMO runs from January 2014 to January 2021.
- Comparison of 56 neonatal patients (57 ECMO runs), with 16 patients having documented IUDE.
Main Results:
- No significant differences in gestational age, ECMO run length, survival to discharge, or major complications.
- Neonates with IUDE required significantly greater use of sedative and analgesic adjuvant medications during ECMO (p < 0.01).
- Trending results showed increased post-ECMO feeding complications and longer total hospitalization in the IUDE group.
Conclusions:
- Prenatal drug exposure in neonates on ECMO influences clinical care, particularly medication requirements.
- While survival and major complications were similar, IUDE is associated with increased need for adjuvant medications and prolonged hospitalization.
- Clinical care strategies should be developed to optimize care for neonates with IUDE requiring ECMO.
Abstract:
The incidence of in utero drug exposure (IUDE) and neonatal extracorporeal membrane oxygenation (ECMO) utilization have both increased over the past decade. However, there are no studies to date that examine the impact that IUDE has on neonates requiring ECMO. In this retrospective cohort study, we compared the clinic course and outcomes of neonates who were placed on ECMO with IUDE vs. neonates without IUDE. Analysis included data extracted from medical records from all neonatal ECMO runs between January 2014 and January 2021 at the University of Kentucky Children's Hospital. A total of 56 neonatal patients were placed on ECMO during this time period and there were a total of 57 ECMO runs. Nearly one-third of neonates (16) had documented IUDE. There were no differences in gestational age, length of ECMO run, survival to discharge, or number of major complications while on ECMO in the neonates with IUDE compared to those without. In contrast, greater use of sedative and analgesic adjuvant medications during ECMO was required for IUDE-ECMO cases (p < 0.01). Trending results indicated that post-ECMO feeding complications and total hospitalization length were also greater in the IUDE-ECMO group. These findings illustrate the complex influence of prenatal drug exposures on neonatal patient care and warrant the development of clinical care strategies optimized for this unique patient group.
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