The Use of Extracorporeal Membrane Oxygenation in Neonates With Congenital Renal Failure

Extracorporeal membrane oxygenation (ECMO) provides support for patients whose heart and lungs cannot oxygenate and circulate blood effectively. ECMO utilization in patients with congenital renal failure (CRF) is variable as are survival outcomes, ranging from 42 to 80 %. We aim to understand ECMO utilization and outcomes in patients with CRF at a free-standing, quaternary care children's hospital with a fetal care center.

We performed a single-center, retrospective cohort study of patients under 30 days of age admitted with a diagnosis of CRF between 2014 and 2024. Patients with non-congenital renal failure were excluded. Continuous variables were compared using two-sample Wilcoxon tests and categorical variables were compared using chi-squared or Fisher's exact tests.

We identified 23 patients with CRF during the study period, 7 of whom required ECMO (30.4 %). ECMO use was associated with higher vasoactive inotrope score (VIS) and oxygenation index (OI) at 4 h of life (p = 0.011 and 0.003, respectively). Survival to discharge was 28.6 % of patients requiring ECMO. Higher 5-min APGAR score, lower 24-h VIS and OI were associated with 30-day survival (p = 0.025, p = 0.049, p = 0.040, respectively). Dialysis was initiated in 10/23 patients, with four also requiring ECMO. Two patients survived to transplantation, and four awaited transplant evaluation at the end of the study period. Patients requiring ECMO underwent 5 times more procedures than those who did not require ECMO (10 versus 2 procedures/patient, p = 0.020).

ECMO utilization in neonates with CRF is resource-intensive and has highly variable outcomes. Further multi-center investigations are warranted to better understand practice differences at the institutional level.