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Extracorporeal membrane oxygenation and term neonatal respiratory failure deaths in the United Kingdom compared with the United States: 1999 to 2005

Brown, Kate L. MScPH, MRCPCH; Sriram, Sudhir MD, MRCP; Ridout, Deborah MSc; Cassidy, Jane MRCPCH; Pandya, Hitesh MRCPCH; Liddell, Morag RN, BSc; Davis, Carl FRCS; Goldman, Allan MRCPCH; Field, David DM, FRCPCH; Karimova, Ann MD

Pediatric Critical Care Medicine: January 2010 - Volume 11 - Issue 1 - p 60-65
doi: 10.1097/PCC.0b013e3181b0644e

Objective: To compare national neonatal extracorporeal membrane oxygenation data and deaths from primary respiratory disorders of term neonates between the United Kingdom and the United States from 1999 to 2005.

Design: Cross-sectional study.

Setting: National data sets from the United Kingdom and the United States.

Patients: Neonatal extracorporeal membrane oxygenation patients submitted to the Extracorporeal Life Support Organization Registry and national birth and death registrations.

Interventions: None.

Measurements and Main Results: Meconium aspiration syndrome was the most common indication for extracorporeal membrane oxygenation in the United Kingdom: 50.6% vs. 25.8% in the United States (p < .001). Congenital diaphragmatic hernia was most common indication for extracorporeal membrane oxygenation in the United States: 30.7% vs. 15.4% in the United Kingdom (p < .001).

Extracorporeal membrane oxygenation use was greater in the United States than the United Kingdom: rate ratio, 1.81 (95%, confidence interval, 1.64, 2.00). The extracorporeal membrane oxygenation rate decreased over time in the United States (p < .001) but was unchanged for all diagnoses in the United Kingdom (p = .49). The rates of extracorporeal membrane oxygenation use for meconium aspiration syndrome were equivalent in both countries: rate ratio, 0.92 (95% confidence interval, 0.80, 1.07) but greater in the United States for congenital diaphragmatic hernia: rate ratio, 3.60, (95% confidence interval, 2.82, 4.66) and persistent pulmonary hypertension newborn: rate ratio, 4.67 (95% confidence interval, 3.33, 6.74).

National neonatal death rates included nonextracorporeal membrane oxygenation + extracorporeal membrane oxygenation death. Meconium aspiration syndrome deaths were equivalent overall between the two countries: rate ratio, 0.99 (95% confidence interval, 0.77, 1.29), but decreased in the United States (p < .001) although not in the United Kingdom (p = .17). Congenital diaphragmatic hernia deaths were more prevalent in the United Kingdom than in the United States: rate ratio, 1.57 (95% confidence interval, 1.34, 1.84).

Conclusions: Extracorporeal membrane oxygenation is used more often in the United States: clinicians seem less willing to offer extracorporeal membrane oxygenation for persistent pulmonary hypertension of the newborn and congenital diaphragmatic hernia in the United Kingdom. In contrast to the United States, no reduction in either extracorporeal membrane oxygenation use or death due to meconium aspiration syndrome was observed in the United Kingdom. Early transfer to a tertiary center is recommended for term neonates with respiratory failure.

From the Cardiac Critical Care (KLB, AG, AK), Great Ormond Street Hospital for Children, London, UK; Section of Neonatology (SS), University of Chicago, Chicago, IL; Institute of Child Health (DR), UCL Centre for Paediatric Epidemiology and Biostatistics, London, UK; Department of Pediatric Intensive Care Unit (JC), Freeman Hospital, Newcastle upon Tyne, UK; Department of Pediatric Intensive Care Unit (HP), Glenfield Hospital, Leicester, UK; Department of Paediatric Surgery (ML, CD), Royal Hospital for Sick Children, Glasgow, UK; and the Neonatal Unit (DF), Leicester Royal Infirmary, Leicester, UK.

The study was registered with and granted approval by the Research and Development Office at The Institute of Child Health, London, UK.

The authors have not disclosed any potential conflicts of interest.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies