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Severe respiratory failure in neonates: mortality and morbidity rates and neurodevelopmental outcomes
M C Walsh-Sukys1, R E Bauer, D J Cornell
1Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.
Insights
Extracorporeal membrane oxygenation (ECMO) improved pulmonary outcomes for neonates with severe respiratory illness, with similar survival and neurodevelopmental outcomes compared to conventional therapy. ECMO survivors experienced fewer chronic lung issues and rehospitalizations.
Area of Science:
- Neonatal care
- Pediatric critical care
- Respiratory medicine
Background:
- Severe neonatal respiratory illness poses significant risks to infant survival and long-term health.
- Extracorporeal membrane oxygenation (ECMO) is an advanced life support technique used for critically ill neonates.
- Understanding the comparative outcomes of ECMO versus conventional therapy is crucial for clinical decision-making.
Purpose of the Study:
- To compare survival, neurodevelopmental, and health outcomes in neonates with severe respiratory illness treated with and without ECMO.
- To evaluate the long-term pulmonary and neurological sequelae in survivors.
- To inform treatment strategies for severe neonatal respiratory distress.
Main Methods:
- Prospective data collection on clinical and demographic factors of neonates meeting severe illness criteria.
- Follow-up assessments at 8 and 20 months of age to evaluate health and neurodevelopmental outcomes.
- Comparison of outcomes between neonates treated with conventional therapy and those receiving ECMO, with treatment assignment by attending physician.
Main Results:
- Neonates treated with ECMO demonstrated higher survival rates (90%) compared to conventional therapy (69%).
- ECMO-treated survivors had significantly better pulmonary outcomes, including less chronic lung disease and fewer rehospitalizations.
- Neurodevelopmental impairment rates were similar between ECMO-treated (26%) and conventionally treated (24%) survivors, though macrocephaly was observed in 24% of ECMO patients.
Conclusions:
- Survivors of severe neonatal respiratory illness face substantial pulmonary and neurodevelopmental challenges irrespective of treatment modality.
- ECMO offers superior pulmonary outcomes for neonates with severe respiratory illness compared to conventional management.
- While neurodevelopmental outcomes were comparable, ECMO presents a viable option for improving respiratory health in critically ill neonates.
Objective:
To compare the survival, neurodevelopmental, and health outcomes of children with severe respiratory illness treated with and without extracorporeal membrane oxygenation (ECMO).
Design:
Prospective collection of clinical and demographic data of all neonates reaching illness severity criteria, with follow-up at 8 and 20 months of age. Patients were assigned to treatment by the attending physician.
Patients:
Consecutive sample of 74 neonates during a 24-month period with an alveolar-to-arterial gradient exceeding 620 for 8 or more hours.
Results:
Eighteen (69%) of 26 neonates treated with conventional therapy survived to 20 months, in comparison with 43 (90%) of 48 neonates treated with ECMO. The conventionally treated group had significantly more chronic lung disease, longer duration of oxygen therapy, more chronic reactive airway disease, and more rehospitalizations than those treated with ECMO. Hospital charges were similar in the two groups. Macrocephaly was noted in 24% of those treated with ECMO and in none of the conventional group. Of those completing evaluation, 4 (24%) of 17 conventionally treated survivors and 20 (26%) of 38 ECMO-treated survivors had neurodevelopmental impairment.
Conclusion:
Survivors of severe neonatal respiratory illness have significant pulmonary and neurodevelopmental impairment, regardless of the treatment used. Neonates treated with ECMO had neurodevelopmental outcomes similar to those of patients treated conventionally, but better pulmonary outcomes.