A comparison of clinical variables that predict adverse outcome in term infants with severe respiratory failure randomised to a policy of extracorporeal membrane oxygenation or to conventional neonatal intensive care.
OBJECTIVE
To identify clinical variables predicting adverse outcome in a group of infants with severe respiratory failure who were randomized either to referral for extra-corporeal membrane oxygenation (ECMO) or to conventional neonatal intensive care within the United Kingdom.


METHODS
Adverse outcome was defined by death or disability by four years of age. Receiver operator characteristic (ROC) plots were constructed for variables with continuous data and relative risk (RR) with 95% confidence intervals (CI) calculated for binominal data.


RESULTS
Of variables measurable at trial entry, congenital diaphragmatic hernia and lower birthweight was also associated with increased mortality and morbidity. Seizures or supplementary oxygen at discharge were markers of disease course, which predicted a poorer outcome amongst survivors. These variables behaved similarly in the two trial groups. Those infants in the ECMO group with an episode of sepsis, established full sucking feeds after 14 days of age or a hospital stay over 30 days were at increased risk of disability.


CONCLUSIONS
This study has identified clinical variables that predict adverse outcome for term infants with severe respiratory failure. The results may assist clinicians caring for these babies, when counseling their families and in the development of guidelines for neonatal ECMO.
Bennett
Charlotte C
CC
Department of Neonatal Medicine, John Radcliffe Hospital, Oxford, U.K. ccbennett@doctors.org.uk
Johnson
Ann
A
Field
David J
DJ
D019988:Children with Disabilities; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D009017:Morbidity; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012640:Seizures / Q000150:complications / Q000628:therapy; D018805:Sepsis / Q000150:complications; D013391:Sucking Behavior; D016896:Treatment Outcome