title: Outcome in neonates with congenital heart disease referred for respiratory extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  To evaluate the proportion of neonates referred for extracorporeal membrane oxygenation (ECMO) support in the modern era of advanced conventional treatments for respiratory failure who actually had congenital heart disease (CHD), and to assess the impact of this diagnostic route on patient condition and outcome.
  
  
  METHODS
  A retrospective case-note review of neonatal ECMO and cardiac admissions to a single, tertiary ECMO and cardiac intensive care unit (ICU) between March 1999 and February 2002.
  
  
  RESULTS
  287 symptomatic neonates presented to the ICU with previously undiagnosed cardiac or respiratory disease. Eighty-two with presumed respiratory failure were referred for ECMO, and 205 with suspected CHD were referred for cardiac evaluation. Eight (10%) ECMO referrals, all with presumed persistent pulmonary hypertension of the newborn (PPHN), were found to have CHD (transposition: 3; total anomalous pulmonary venous connection: 3; left heart obstructive lesions: 2). Mortality in this group was 50%, compared with 11% for correctly identified CHD patients (odds ratio 8.2, 95% CI 1.92, 35.4, p<0.01). For all neonates with CHD, the risk of death was increased by the presence of cardiovascular collapse and end-organ dysfunction at presentation to the ICU (p<0.01 for both).
  
  
  CONCLUSIONS
  Neonates with CHD may present as severe "PPHN" via the ECMO service. Poor outcome in these patients relates to the high incidence of cardiovascular collapse and end-organ dysfunction. Early echocardiography is recommended for neonates with presumed PPHN. Neonatal ECMO support should be based in centres with cardiac surgical services.
authors.affiliation: Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK. brownk@gosh.nhs.uk
authors.forename: Kate L
authors.initials: KL
authors.lastname: Brown
authors.forename: Fiona
authors.initials: F
authors.lastname: Miles
authors.forename: Ian D
authors.initials: ID
authors.lastname: Sullivan
authors.forename: Aparna
authors.initials: A
authors.lastname: Hoskote
authors.forename: Linda
authors.initials: L
authors.lastname: Verhulst
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Ridout
authors.forename: Allan P
authors.initials: AP
authors.lastname: Goldman
mesh_terms: D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome