Medical and financial impact of a neonatal extracorporeal membrane oxygenation referral center in the nitric oxide era.
OBJECTIVE
The primary objective of this study was to determine whether widespread use of nitric oxide after Food and Drug Administration approval decreased admissions to a neonatal referral center for extracorporeal membrane oxygenation evaluation. We also sought to determine whether antecedent treatment delayed eventual transfer, resulting in sicker patients, increased mortality, increased extracorporeal membrane oxygenation application, and higher direct costs of care.


METHODS
This was a retrospective cohort study of all of the patients transferred to a neonatal referral center for extracorporeal membrane oxygenation evaluation before (1995-1999) and after (2000-2005) Food and Drug Administration approval of nitric oxide. Patients were divided into "congenital diaphragmatic hernia" and "persistent pulmonary hypertension" (all other diagnoses) for additional analysis.


RESULTS
Admission rates for extracorporeal membrane oxygenation evaluation decreased in the nitric oxide era, and eventual transfer was not delayed. Persistent pulmonary hypertension patients had improved oxygen indexes, a trend toward decreased mortality, decreased extracorporeal membrane oxygenation use, and decreased direct costs. Congenital diaphragmatic hernia patients had unchanged physiologic measurements, mortality, and extracorporeal membrane oxygenation use with increased direct costs of care. As a whole, outcomes for patients transferred for extracorporeal membrane oxygenation evaluation improved, whereas direct costs were unchanged.


CONCLUSIONS
Persistent pulmonary hypertension patients had improved outcomes with decreased costs, whereas congenital diaphragmatic hernia patients had unchanged outcomes with increased costs. Overall, patients admitted to this NICU because of the presence of extracorporeal membrane oxygenation services had improved outcomes without increased costs in the nitric oxide era.
Pawlik
Theodore David
TD
Northwest Newborn Specialists PC, Portland, Oregon, USA. davepawlikmd@yahoo.com
Porta
Nicolas Francisco Marcos
NF
Steinhorn
Robin Heise
RH
Ogata
Edward
E
deRegnier
Raye-Ann Odegaard
RA
D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics* / Q000639:trends; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D007087:Illinois; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000008:administration & dosage; D012017:Referral and Consultation / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies; D013995:Time
D009569:Nitric Oxide