Outcomes in early term neonates requiring extracorporeal membrane oxygenation

To evaluate ECMO-related morbidity and mortality between early-term (ET) and Full-term (FT) infants.

We performed a retrospective review of 3,831 neonatal ECMO runs for meconium aspiration syndrome (MAS) and/or persistent pulmonary hypertension of the newborn (PPHN) in the Extracorporeal Life Support Organization (ELSO) Registry from 2007 to 2017. Neonates born at 37^0/7-38^6/7 weeks were classified as ET and those born at 39^0/7-40^6/7 weeks were classified as FT. Primary outcomes were ECMO survival and survival to discharge. Secondary outcomes were complications while on ECMO. Data were analyzed using Mann-Whitney U and Fisher's Exact testing. Logistic regression was performed to assess odds of ECMO survival for factors noted to be significantly different between groups.

Of 2,551 infants who met inclusion criteria based on gestational age, we identified 805 (32 %) ET and 1,746 (68 %) FT infants. ET infants had significantly lower ECMO survival (90 vs. 94 %, p<0.01) and survival to discharge (80 vs. 88 %, p<0.01), more neurologic complications on ECMO (15 vs. 12 %, p=0.024), and increased need for hemofiltration (33 vs. 29 %, p=0.033). There were no statistically significant differences between groups in mechanical, hemorrhagic, infectious, metabolic, renal, pulmonary, limb, or cardiovascular complications while on ECMO. Multiple logistic regression showed that ET gestational age, development of neurologic complications on ECMO, and need for hemofiltration are independent negative predictors of ECMO survival.

ET gestational age is an independent risk factor for worse ECMO outcomes and survival in comparison to FT infants, highlighting the vulnerability of this population.