Faculty Collaboration Database

How low can you go? Effectiveness and safety of extracorporeal membrane oxygenation in low-birth-weight neonates. J Pediatr Surg 2004 Jun;39(6):845-7

Date

06/09/2004

Pubmed ID

15185209

DOI

10.1016/j.jpedsurg.2004.02.012

Scopus ID

2-s2.0-3042579615 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

PURPOSE: Controversy exists regarding the criteria for placement of infants on extracorporeal membrane oxygenation (ECMO) at low birth weights. The authors hypothesized that ECMO is effective and safe in babies under 2 kg and sought to examine outcome and survival rate in these infants.

METHODS: All patients less than 30 days old in the Extracorporeal Life Support Organization (ELSO) registry (n = 14,305) were divided into those less than 2 kg (n = 663) and more than 2 kg (n = 13,642). Multiple regression analysis determined factors that predicted survival rate and the lowest safe weight for ECMO.

RESULTS: Overall survival rate was 76% and was lower in infants less than 2 kg (> or =2 kg, 77% v <2 kg, 53%, P <.0001). Survival rate was significantly lower for patients with diaphragmatic hernia (CDH), bleeding, and intracranial hemorrhage (ICH) by regression. The incidence of ICH in babies less than 2.0 kg was 6% versus 4% in those more than 2.0 kg (P <.05). Regression analysis determined that the lowest weight at which a survival rate of 40% could be achieved was 1.6 kg.

CONCLUSIONS: Cannulation for ECMO may be safe and effective in babies under 2.0 kg and potentially as low as 1.6 kg. Judicious anticoagulation might limit bleeding, which occurred in a minority of these patients.

Author List

Rozmiarek AJ, Qureshi FG, Cassidy L, Ford HR, Gaines BA, Rycus P, Hackam DJ

Author

Laura Cassidy PhD Associate Dean, Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Apgar Score
Birth Weight
Carbon Dioxide
Extracorporeal Membrane Oxygenation
Female
Gestational Age
Hernia, Diaphragmatic
Hernias, Diaphragmatic, Congenital
Humans
Incidence
Infant, Low Birth Weight
Infant, Newborn
Intracranial Hemorrhages
Male
Registries
Survival Rate
Treatment Outcome