title: Pushing the boundaries of ECLS: Outcomes in <34 week EGA neonates.
abstract: OBJECTIVE
  Extracorporeal life support (ECLS) is usually reserved for infants ≥34weeks estimated gestational age (EGA) owing to concerns about increased mortality and incidence of intracranial hemorrhage (ICH). We sought to characterize survival, rates of ICH, and complications in <34week EGA neonates placed on ECLS.
  
  
  METHODS
  752 neonates of EGA 29-34weeks were identified in the Extracorporeal Life Support Organization (ELSO) Registry (1976-2008). Data analyzed included birthweight, survival, pre-ECLS conditions, ventilatory parameters and complications (including ICH and other neurological outcomes). Data were compared using t-test, Chi-square and logistic regression analyses.
  
  
  RESULTS
  When compared to survival rates of 34week EGA neonates (58%), survival was statistically different for 29-33week EGA (48%, p=0.05). No significant difference in ICH incidence was seen between the 29-33week and 34week groups (21% vs. 17%, respectively), but a significant difference was seen in the incidence of cerebral infarct between groups (22% for 29-33weeks vs. 16% for 34weeks; p=0.03). ICH and survival did not correlate with EGA during logistic regression analysis.
  
  
  CONCLUSIONS
  Though rates of survival and cerebral infarction were worse at 29-33weeks EGA compared with 34weeks, these differences were modest and may be clinically acceptable. This suggests that EGA<34weeks may not be an absolute contraindication to use of ECLS.
  
  
  METHODS
  III.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI. Electronic address: jchurc@med.umich.edu.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Church
authors.affiliation: Department of Pediatric Surgery-General and Thoracic Surgery, University Hospital Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kim
authors.affiliation: Division of Pediatric Surgery, University of North Carolina Department of Surgery, Chapel Hill, NC.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Erickson
authors.affiliation: Austin Pediatric Surgery, Dell Children's Medical Center, Austin, TX.
authors.forename: Ankur
authors.initials: A
authors.lastname: Rana
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI.
authors.forename: Robert
authors.initials: R
authors.lastname: Drongowski
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI.
authors.forename: George B
authors.initials: GB
authors.lastname: Mychaliska
mesh_terms: D001724:Birth Weight; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D020300:Intracranial Hemorrhages / Q000401:mortality; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate
keywords: ECLS; ECMO; Intracranial hemorrhage (ICH); Prematurity