Sourabh Verma, Bryn H. S. Seltzer, Jason C. Fisher, Erin Cicalese
Hassenfeld Children’s Hospital at New York University Langone.
United States
Journal of Perinatal Medicine
J Perinat Med 2025;
DOI: 10.1515/jpm-2025-0235
Abstract
Objectives: To evaluate ECMO-related morbidity and mortality between Early-term (ET) and Full-term (FT) infants.
Methods: We performed a retrospective review of 3,831 neonatal ECMO runs for meconium aspiration syndrome (MAS) and/or persistent pulmonary hypertension of the newborn (PPHN) in the Extracorporeal Life Support Organization (ELSO) Registry from 2007 to 2017. Neonates born at 370/7-386/7 weeks were classified as ET and those born at 390/7-406/7 weeks were classified as FT. Primary outcomes were ECMO survival and survival to discharge. Secondary outcomes were complications while on ECMO. Data were analyzed using Mann-Whitney U and Fisher’s Exact testing. Logistic regression was performed to assess odds of ECMO survival for factors noted to be significantly different between groups.
Results: Of 2,551 infants who met inclusion criteria based on gestational age, we identified 805 (32 %) ET and 1,746 (68 %) FT infants. ET infants had significantly lower ECMO survival (90 vs. 94 %, p<0.01) and survival to discharge (80 vs. 88 %, p<0.01), more neurologic complications on ECMO (15 vs. 12 %, p=0.024), and increased need for hemofiltration (33 vs. 29 %, p=0.033). There were no statistically significant differences between groups in mechanical, hemorrhagic, infectious, metabolic, renal, pulmonary, limb, or cardiovascular complications while on ECMO. Multiple logistic regression showed that ET gestational age, development of neurologic complications on ECMO, and need for hemofiltration are independent negative predictors of ECMO survival.
Conclusions: ET gestational age is an independent risk factor for worse ECMO outcomes and survival in comparison to FT infants, highlighting the vulnerability of this population.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes