Original articleNeonatal extracorporeal life support: Impact of new therapies on survival
Section snippets
Methods
This study was approved by the Children’s Memorial Hospital Institutional Review Board. We queried the Extracorporeal Life Support Organization Registry, which collects demographic, clinical course, and outcomes data on every patient cannulated for ECLS from 99 ECLS centers in 13 countries worldwide.21 For this study, we analyzed the first-run information for all neonates with known survival information cannulated for ECLS for respiratory reasons between January 1, 1996 and December 31, 2003.
Results
During the study period, 7017 neonates were cannulated for ECLS for respiratory indications. From 1996 to 2003 the number of neonates cannulated for ECLS decreased by 26.6 % (Figure 1). Cannulation rates decreased the most for infants with sepsis (64.8%), RDS (55.8%), and MAS (45.9%), with smaller reductions noted for infants with PPHN (4.6%) and CDH (2.2%). Cannulation rates increased by 16.5% for infants with “other” diagnoses.
Mortality on ECLS was 26.4% during the study years, with similar
Discussion
This study reports on associations between mortality in ECLS patients and recently developed rescue therapies provided before the initiation of ECLS. Over the 8 years of the study, the use of NO, HFV, and surfactant all increased, accompanied by a marked decline in the total number of infants cannulated for ECLS because of MAS, RDS, and sepsis. Minimal changes were seen in the number of cannulated infants with PPHN and CDH, and the use of ECLS for other diagnoses increased. These data suggest
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Development and validation of the neonatal risk estimate score for children using extracorporeal respiratory support
2016, Journal of PediatricsCitation Excerpt :We also included variables in neonatal mortality risk adjustment models13 published after January 1, 2000: Score for Neonatal Acute Physiology-II (SNAP-II),14,15 SNAP Perinatal Extensions-II (SNAPPE-II),14,15 Vermont Oxford Network-Risk Adjustment (VON-RA),15 and Agency for Healthcare Research and Quality neonatal indicator.16 The following candidate variables were identified: patient age,17,18 gestational age,15,19 birth weight,14,17,19-21 sex,15,19 primary diagnosis,17-23 pre-ECMO renal failure,24 comorbid conditions,15,16 pre-ECMO cardiac arrest,17,22 and pre-ECMO measures including arterial blood pH,19,21 the PaCO2,21 and the ratio of PaO2 to fraction of inspired oxygen (PF ratio),14 oxygenation index (OI),25 Apgar,14,15,19,21 mean arterial pressure,14 and pre-ECMO use of inhaled nitric oxide22 or surfactant.18 Primary diagnoses were divided into categories using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes (Table I; available at www.jpeds.com).
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2015, Paediatric Respiratory ReviewsCitation Excerpt :Starting iNO at an OI between 15 and 25 compared with initiation at an OI of greater than 25 in term and near term infants resulted in better oxygenation, but did not reduce the incidence of ECMO/mortality [41]. In infants with CDH, iNO has been shown to have only a short term effect on oxygenation, hence it may have a place for stabilising infants prior to ECMO [42]. In a RCT, iNO was not found to reduce the need for ECMO or death in infants with CDH [43].
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2015, Seminars in Pediatric SurgeryCitation Excerpt :Thus, 85–90% of the cardiac output is shunted away from the lungs, through the FO and DA, to the systemic circulation. There is also increased production of vasoconstrictors, such as endothelin-1 (ET-1), and decreased production of vasodilators such as nitric oxide (NO) and prostacyclin (PGI2), all of which keep the basal pulmonary vascular tone high.5 As the fetus approaches term, the levels of NO and PGI2 increase in preparation for increased pulmonary blood flow once the fetus is born.
Diagnosis and treatment of pulmonary hypertension in infancy
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2012, Clinics in PerinatologyCitation Excerpt :However, because overall ECMO survival has diminished over the same time period, some physicians have speculated that these new treatment modalities may delay ECMO cannulation and negatively affect mortality and morbidity in those infants that require ECMO. In an analysis of data from the Extracorporeal Life Support Organization registry between 1996 and 2003, use of iNO, high-frequency ventilation, and surfactant was not associated with any adverse outcomes during ECMO, including increased hours on ECMO or increased time to extubation.18 Furthermore, surfactant and iNO use were associated with lower ECMO mortality, and iNO use was associated with a decreased risk of cardiac arrest before cannulation.
Persistent Pulmonary Hypertension
2012, Avery's Diseases of the Newborn (Ninth Edition)