How does the changing profile of infants who are referred for extracorporeal membrane oxygenation affect their overall respiratory outcome?

• Published in: Pediatrics (Evanston) Vol. 120; no. 4; p. e762
• Main Authors: Beardsmore, Caroline S, Westaway, Jennifer, Killer, Hilliary, Firmin, Richard K, Pandya, Hitesh
• Format: Journal Article
• Language: English
• Published: United States 01.10.2007
• Subjects: Age Factors; Extracorporeal Membrane Oxygenation; Female; Follow-Up Studies; Hemorrhage - therapy; Hernia, Diaphragmatic - therapy; Hernias, Diaphragmatic, Congenital; Humans; Infant; Lung Volume Measurements; Male; Outcome Assessment (Health Care); Randomized Controlled Trials as Topic; Referral and Consultation; Respiratory Tract Diseases - therapy; Sepsis - therapy; United Kingdom
• ISSN: 1098-4275
• DOI: 10.1542/peds.2006-1955

Extracorporeal membrane oxygenation has been shown to be effective in term neonates with severe but reversible lung disease within the context of randomized, controlled trials. Extracorporeal membrane oxygenation now has been open to a wider population of infants in the United Kingdom, and other treatments have become available. The population referred for extracorporeal membrane oxygenation, therefore, has changed. The aims of this study were to (1) compare respiratory outcomes of infants who received extracorporeal membrane oxygenation in recent years with those from 10 years ago and (2) determine whether respiratory outcome varied with diagnostic group. All infants who were referred to a single extracorporeal membrane oxygenation center and were <12 months old during a 7-year period were eligible. One year after extracorporeal membrane oxygenation, lung volume, airway conductance, maximum expiratory flow, and indices of tidal breathing were measured. A total of 106 infants (77% of those eligible) were tested, and results were compared with those of 51 infants referred for extracorporeal membrane oxygenation as part of the original United Kingdom extracorporeal membrane oxygenation trial. Lung volume was not different, but there was a strong trend for the infants who were seen in more recent years to have better forced expiratory flow and specific airway conductance. Restricting analysis to the major subgroup (meconium aspiration) confirmed these findings. When divided into diagnostic subgroups, infants who required extracorporeal membrane oxygenation for respiratory distress syndrome or who were >2 weeks old when extracorporeal membrane oxygenation was commenced had a poorer respiratory outcome than others. The respiratory outcome of infants who were treated beyond the tightly regulated criteria of the United Kingdom trial remains good and even shows a trend toward improvement. Certain subgroups require extracorporeal membrane oxygenation for longer and have poorer pulmonary function when followed up.