Risk factors, incidence, and outcomes of neonatal respiratory extracorporeal membrane oxygenation including association with therapeutic hypothermia in California during 2013-2020

J Perinatol. 2024 Oct;44(10):1442-1447. doi: 10.1038/s41372-024-02067-2. Epub 2024 Aug 4.

Abstract

Objective: To evaluate the incidence, indications and outcomes with neonatal extracorporeal membrane oxygenation (ECMO) and its association with therapeutic hypothermia (TH) among infants undergoing invasive mechanical ventilation (IMV) in California during 2013-2020.

Study design: We analyzed data on neonates ≥34 weeks gestation with ≥4 h of IMV over an 8-year period (2013-2020) from the California Perinatal Quality Care Collaborative (CPQCC) database.

Results: Between 2013 and 2020, the ranges for utilization of iNO (13.9 to 17.2%), ECMO (2.1 to 2.5%), TH (10.2 to 15.7%) and TH + ECMO (0.4 to 0.8%) were observed. The most common association with neonatal ECMO was TH (148 cases, OR 3.2, 95% CI 2.6-4.3, p < 0.01). The combination of meconium aspiration syndrome (MAS) and hypoxic ischemic encephalopathy (HIE) increased risk of iNO and ECMO use (OR 11.3, 1.5-86.9), p = 0.02).

Conclusion: Ventilated infants ≥34 weeks gestational age undergoing TH are at risk for iNO/ECMO use and need close monitoring.

MeSH terms

  • California / epidemiology
  • Extracorporeal Membrane Oxygenation* / statistics & numerical data
  • Female
  • Gestational Age
  • Humans
  • Hypothermia, Induced* / statistics & numerical data
  • Hypoxia-Ischemia, Brain* / epidemiology
  • Hypoxia-Ischemia, Brain* / therapy
  • Incidence
  • Infant, Newborn
  • Male
  • Meconium Aspiration Syndrome* / epidemiology
  • Meconium Aspiration Syndrome* / therapy
  • Respiration, Artificial* / statistics & numerical data
  • Respiratory Distress Syndrome, Newborn / epidemiology
  • Respiratory Distress Syndrome, Newborn / therapy
  • Retrospective Studies
  • Risk Factors