Extracorporeal membrane oxygenation (ECMO) in neonates with severe uropathies: A single-center experience

Extracorporeal membrane oxygenation (ECMO) is an advanced extracorporeal life support rarely used in neonates with severe uropathies. This study describes our experience with ECMO support in five neonates presenting with life-threatening respiratory failure associated with congenital uropathy.

We conducted a retrospective review on five neonates treated with ECMO between 2015 and 2024. All had severe uropathies (four with posterior urethral valves, one with a solitary dysplastic cystic kidney) and required ECMO for refractory hypoxia. Veno-arterial jugular-carotid cannulation was used in all cases. Data collected included procedural details, renal and neurological outcomes, and follow-up.

Median gestational age was 36 weeks. ECMO was initiated at a median of 1 day of life for a median duration of 6 days. No procedural mortality occurred. One circuit failure and one jugular thrombosis occurred. Three patients survived. Two had stable renal function; one developed chronic kidney disease stage 5 (CKD-5). Neurological outcomes were encouraging. At follow-up, two children had normal development, one had psychomotor delay.

ECMO is a reliable rescue strategy in selected neonates even with uropathies experiencing respiratory failure. Complication rates remained within reasonable limits for such critical interventions, and long-term outcomes varied, underscoring the need for individualized multidisciplinary care.