title: Survival of newborn infants with severe respiratory failure before and after establishing an extracorporeal membrane oxygenation program.
abstract: BACKGROUND
  Severe hypoxic respiratory failure is a leading cause of neonatal mortality in Chile. Extracorporeal membrane oxygenation improves survival in neonates with hypoxic respiratory failure.
  
  
  OBJECTIVE
  To determine the impact of the establishment of a Neonatal Extracorporeal Membrane Oxygenation Program on the outcome of newborns with severe hypoxic respiratory failure in a developing country.
  
  
  METHODS
  Data of newborns (birthweight > 2,000 g and gestational age ≥ 35 wk) with hypoxic respiratory failure and oxygenation index greater than 25 were compared before and after extracorporeal membrane oxygenation was available. Extracorporeal membrane oxygenation was initiated in infants with refractory hypoxic respiratory failure who failed to respond to inhaled nitric oxide/high-frequency oscillatory ventilation.
  
  
  RESULTS
  Data from 259 infants were analyzed; 100 born in the pre-extracorporeal membrane oxygenation period and 159 born after the extracorporeal membrane oxygenation program was established. Patients were similar in terms of risk factors for death for both periods except for a higher oxygenation index and a greater proportion of outborn infants during the extracorporeal membrane oxygenation period. Survival significantly increased from 72% before extracorporeal membrane oxygenation to 89% during the extracorporeal membrane oxygenation period (p < 0.01). During the extracorporeal membrane oxygenation period, 98 of 159 patients (62%) with hypoxic respiratory failure were rescued using inhaled nitric oxide/high-frequency oscillatory ventilation, whereas 61 (38%) did not improve; 52 of these 61 neonates were placed on extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survival rate to discharge was 85%. After adjusting for potential confounders, the severity of the pretreatment oxygenation index, a late arrival to the referral center, the presence of a pneumothorax, and the diagnosis of a diaphragmatic hernia were significantly associated with the need for extracorporeal membrane oxygenation or death.
  
  
  CONCLUSIONS
  The establishment of an extracorporeal membrane oxygenation program was associated with a significant increase in the survival of newborns more than or equal to 35 weeks old with severe hypoxic respiratory failure.
authors.affiliation: 1Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 2Division of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 3ECMO-UC Group, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 4Department of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Javier
authors.initials: J
authors.lastname: Kattan
authors.forename: Alvaro
authors.initials: A
authors.lastname: González
authors.forename: Pedro
authors.initials: P
authors.lastname: Becker
authors.forename: Miriam
authors.initials: M
authors.lastname: Faunes
authors.forename: Alberto
authors.initials: A
authors.lastname: Estay
authors.forename: Paulina
authors.initials: P
authors.lastname: Toso
authors.forename: Soledad
authors.initials: S
authors.lastname: Urzúa
authors.forename: Andrés
authors.initials: A
authors.lastname: Castillo
authors.forename: Jorge
authors.initials: J
authors.lastname: Fabres
mesh_terms: D001993:Bronchodilator Agents / Q000627:therapeutic use; D002677:Chile / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000150:complications; D009569:Nitric Oxide / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010547:Persistent Fetal Circulation Syndrome / Q000150:complications; D011030:Pneumothorax / Q000150:complications; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D061665:Time-to-Treatment
chemical_list: D001993:Bronchodilator Agents; D009569:Nitric Oxide; D010100:Oxygen