[Evolution of extracorporeal membrane oxygenation (ECMO) in neonatal acute respiratory failure, fifteen years of experience].
Over the last decade, several new therapies including exogenous surfactant therapy, inhaled nitric oxide and high-frequency ventilation have become available for the treatment of neonatal pulmonary failure. The aim of this retrospective study was to evaluate to what extent these modalities have impacted the use of neonatal extracorporeal membrane oxygenation at our institution and to discuss the role of ECMO in 2003 in the management of newborn infants with refractory hypoxemia.


METHODS
Two hundred and twenty six newborn infants treated by ECMO before 15 days of life and during more than 24 h in our intensive care unit were retrospectively included from two time periods (group 1: 1988-1993 and group 2: 1996-2003).


RESULTS
As compared with the first group, the number of newborns supported by ECMO in the second group has clearly diminished and their severity has increased. Overall survival rate was 80% in the first group and 69% in the second group. Meconium aspiration syndrome remains the major indication for ECMO (44%). Pulmonary sequelae, assessed by bronchopulmonary dysplasia rate (41%) are more frequent that neurologic sequelae (4.8%).


CONCLUSIONS
ECMO remains an useful technique in the management of newborn infants with refractory hypoxemia, with a consideration to institute ECMO early in order to increase survival rate.
Flamant
C
C
Service de réanimation néonatale et pédiatrique, hôpital d'enfants Armand-Trousseau, AP-HP, 26, avenue du Docteur A.-Netter, 75571 Paris 12, France. cyril.flamant@trs.ap-hop-paris.fr
Nolent
P
P
Hallalel
F
F
Lardeux
C
C
Chevalier
J Y
JY
Renolleau
S
S
D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000150:complications; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome