Two years' follow-up of newborn infants after extracorporeal membrane oxygenation (ECMO).
OBJECTIVE
Extracorporeal membrane oxygenation (ECMO) is a technique of extracorporeal oxygenation used in newborn infants with refractory hypoxemia after failure of maximal conventional medical management, when mortality risk is higher than 80%. We retrospectively reviewed all the neonates treated by ECMO between October 1991 and September 1997 in our newborn intensive care unit.


METHODS
Fifty-seven patients were treated with ECMO for severe respiratory failure: congenital diaphragmatic hernia (CDH) (n=23), neonatal sepsis (NS) (n=14), meconium aspiration syndrome (MAS) (n=12), and others (n=8). Mean gestational age and birth weight were 38+/-2 weeks and 3200+/-500 g, respectively. Oxygenation index was 61+/-8. Both venovenous (n=28) or venoarterial ECMO (n=29) were used. The mean time at ECMO initiation was 47 h (range 8 h-2 months). The mean duration was 134+/-68 h. In each case of VA ECMO, carotid reconstruction was performed. Survival at 2 years was 40/57 (70%) (CDH 12/23 (52%), NS 11/14 (79%), MAS 12/12 (100%), others 5/8). Follow-up at 2 years was available in 36 survivors.


RESULTS
Neurodevelopmental outcome was not related to the initial diagnosis: normal neurologic development (n=30), cerebral palsy (n=5), and neurologic developmental delay (n=1). Two patients remained oxygen dependant at 2 years, and four required surgical treatment for severe gastroesophageal reflux. Respiratory and digestive sequelae were more frequent in the CDH group (P<0.01). Patency and flow of the repaired carotid artery was assessed in 20 infants at 1 year of age using Doppler ultrasonography: normal (n=10), <50% stenosis (n=9), and >50% stenosis (n=1).


CONCLUSIONS
ECMO increased survival of newborn infants with refractory hypoxemia. However, higher a survival rate and lower morbidity were found in non-CDH infants than in congenital diaphragmatic hernia.
Jaillard
S
S
Department of Thoracic Surgery, A. Calmette Hospital, Centre Hospitalier Régional et Universitaire de Lille, Bd. du Professeur Leclercq, 59037 cedex, Lille, France. sjaillard@chru-lille.fr
Pierrat
V
V
Truffert
P
P
Métois
D
D
Riou
Y
Y
Wurtz
A
A
Lequien
P
P
Storme
L
L
D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D002560:Cerebrovascular Circulation; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000401:mortality / Q000628:therapy; D007231:Infant, Newborn; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D017585:Ultrasonography, Doppler, Transcranial