Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support
<b>Objective</b>: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO gr...
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MDPI AG
2025-07-01
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| author | Pooja Musuku Keith Meyer Felipe E. Pedroso Fuad Alkhoury Balagangadhar R. Totapally |
| author_facet | Pooja Musuku Keith Meyer Felipe E. Pedroso Fuad Alkhoury Balagangadhar R. Totapally |
| author_sort | Pooja Musuku |
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| description | <b>Objective</b>: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and evaluate the predictive variables requiring ECMO support. <b>Methods</b>: All neonates (<15 days) with respiratory failure (without congenital diaphragmatic hernia or congenital heart disease) referred to our regional ECMO center from 2014 to 2023 were included in this retrospective study. Patient demographics, birth history, and clinical and outcome variables were analyzed. Oxygenation indices and vasoactive–inotropic scores obtained at PICU arrival and four hours after arrival were compared between the two groups using ROC analysis, with ECMO initiation as an outcome variable. Youden’s index was used for optimal threshold values. Chi-square, Mann–Whitney U, and binary logistic regression were used for comparative analyses. <b>Results</b>: Out of the 147 neonates, 96 (65%) required ECMO support. The two groups significantly differed in the prevalence of pulmonary hypertension (pHTN; systemic or suprasystemic pulmonary pressures), lactate level, and oxygenation indices. Mortality was not different between the two groups. Presence of oxygen saturation index (OSI) ≥ 10 had a sensitivity 96.8% in predicting the need for ECMO support. On regression analysis, OSI and pHTN were independent predictors of ECMO support. <b>Conclusions</b>: Oxygenation indices and echo findings predict the need for ECMO support in neonatal hypoxemic respiratory failure. These findings help non-ECMO centers make appropriate and timely transfers of neonates with respiratory failure to ECMO centers. |
| format | Article |
| id | doaj-art-646f872ed3394e4499bd12bab6eeca80 |
| institution | Matheson Library |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj-art-646f872ed3394e4499bd12bab6eeca802025-07-25T13:18:28ZengMDPI AGChildren2227-90672025-07-0112792510.3390/children12070925Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) SupportPooja Musuku0Keith Meyer1Felipe E. Pedroso2Fuad Alkhoury3Balagangadhar R. Totapally4Division of Critical Care Medicine, Nicklaus Children’s Hospital, Miami, FL 33155, USADivision of Critical Care Medicine, Nicklaus Children’s Hospital, Miami, FL 33155, USADepartment of Critical Care Pediatric Surgery, Nicklaus Children’s Hospital, Miami, FL 33155, USADepartment of Critical Care Pediatric Surgery, Nicklaus Children’s Hospital, Miami, FL 33155, USADivision of Critical Care Medicine, Nicklaus Children’s Hospital, Miami, FL 33155, USA<b>Objective</b>: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and evaluate the predictive variables requiring ECMO support. <b>Methods</b>: All neonates (<15 days) with respiratory failure (without congenital diaphragmatic hernia or congenital heart disease) referred to our regional ECMO center from 2014 to 2023 were included in this retrospective study. Patient demographics, birth history, and clinical and outcome variables were analyzed. Oxygenation indices and vasoactive–inotropic scores obtained at PICU arrival and four hours after arrival were compared between the two groups using ROC analysis, with ECMO initiation as an outcome variable. Youden’s index was used for optimal threshold values. Chi-square, Mann–Whitney U, and binary logistic regression were used for comparative analyses. <b>Results</b>: Out of the 147 neonates, 96 (65%) required ECMO support. The two groups significantly differed in the prevalence of pulmonary hypertension (pHTN; systemic or suprasystemic pulmonary pressures), lactate level, and oxygenation indices. Mortality was not different between the two groups. Presence of oxygen saturation index (OSI) ≥ 10 had a sensitivity 96.8% in predicting the need for ECMO support. On regression analysis, OSI and pHTN were independent predictors of ECMO support. <b>Conclusions</b>: Oxygenation indices and echo findings predict the need for ECMO support in neonatal hypoxemic respiratory failure. These findings help non-ECMO centers make appropriate and timely transfers of neonates with respiratory failure to ECMO centers.https://www.mdpi.com/2227-9067/12/7/925ECMOneonatal respiratory failureoxygenation indexvasoactive–inotropic scorepersistent pulmonary hypertension of the newborn |
| spellingShingle | Pooja Musuku Keith Meyer Felipe E. Pedroso Fuad Alkhoury Balagangadhar R. Totapally Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support Children ECMO neonatal respiratory failure oxygenation index vasoactive–inotropic score persistent pulmonary hypertension of the newborn |
| title | Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support |
| title_full | Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support |
| title_fullStr | Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support |
| title_full_unstemmed | Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support |
| title_short | Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support |
| title_sort | clinical characteristics and outcomes for neonates with respiratory failure referred for extracorporeal membrane oxygenator ecmo support |
| topic | ECMO neonatal respiratory failure oxygenation index vasoactive–inotropic score persistent pulmonary hypertension of the newborn |
| url | https://www.mdpi.com/2227-9067/12/7/925 |
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