title: The impact of ethnic population dynamics on neonatal ECMO outcomes: a single urban institutional study.
abstract: BACKGROUND
  Neonatal extracorporeal membrane oxygenation ECMO has been clinically used for the last 25 y. It has been an effective tool for both cardiac and non cardiac conditions. The impact of ethno-demographic changes on ECMO outcomes however remains unknown. We evaluated a single institution's experience with non cardiac neonatal ECMO over a 28-y period.
  
  
  METHODS
  A retrospective review of all neonates undergoing noncardiac ECMO between the y 1984 and 2011 was conducted and stratified into year groups I, II, III (≤1990, 1991-2000, and ≥2001). Demographic, clinical, and outcome data were collected. The patient specifics, ECMO type, ECMO length, blood use, complications, and outcomes were analyzed. Univariate, bivariate, and multivariate analyses were then performed.
  
  
  RESULTS
  Data was available for 827 patients. The number of African-American and Hispanic patients increased over the last 27 y (27.5% versus 45.0% and 3.3% versus 21.5%, year group I versus year group III, respectively). The proportion of congenital diaphragmatic hernia (CDH) patients by ethnicity also increased for African-Americans and Hispanics between the two year groups (22.0% to 33.0% and 4.9% to 33.0%, respectively). Similar pattern was noted for non-CDH diagnoses. Low birth weight, low APGAR scores, CDH, primary pulmonary hypertension, central nervous system hemorrhage, and ECMO were independent predictors of mortality. Ethnicity, in itself however, was not associated with mortality on adjusted analysis.
  
  
  CONCLUSIONS
  More African-Americans and Hispanics have required ECMO over the years with a concurrent decrease in the number of Caucasians. While ethnicity was not an independent predictor of mortality, it appears to be a surrogate for fatal but sometime preventable diagnoses among minorities. Further investigations are needed to better delineate the reason behind this disparity.
authors: Department of Surgery, Howard University College of Medicine, Washington, District of Columbia, USA.
authors: Tolulope A
authors: TA
authors: Oyetunji
authors: Alexandra
authors: A
authors: Thomas
authors: Tara D
authors: TD
authors: Moon
authors: Michael A
authors: MA
authors: Fisher
authors: Edward
authors: E
authors: Wong
authors: Billie L
authors: BL
authors: Short
authors: Faisal G
authors: FG
authors: Qureshi
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data; D004219:District of Columbia / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006548:Hernia, Diaphragmatic / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data