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Survival of Newborn Infants With Severe Respiratory Failure Before and After Establishing an Extracorporeal Membrane Oxygenation Program*

Kattan, Javier MD1,2,3; González, Alvaro MD1,2,3; Becker, Pedro MD1,3,4; Faunes, Miriam RN1,2,3; Estay, Alberto MD1,2,3; Toso, Paulina MD1,2,3; Urzúa, Soledad MD1,2,3; Castillo, Andrés MD1,3; Fabres, Jorge MD, MSPH1,2,3

Pediatric Critical Care Medicine: November 2013 - Volume 14 - Issue 9 - p 876–883
doi: 10.1097/PCC.0b013e318297622f
Neonatal Intensive Care

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.

Design/Patients: 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.

Main 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.

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.

* See also p. 900.

This study was performed at the Pontificia Universidad Católica Hospital, Santiago, Chile.

Drs. Kattan and González contributed equally to this work.

The authors have disclosed that they do not have any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies