Published online September 17, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e762-e768 (doi:10.1542/peds.2006-1955)
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ARTICLE

How Does the Changing Profile of Infants Who Are Referred for Extracorporeal Membrane Oxygenation Affect Their Overall Respiratory Outcome?

Caroline S. Beardsmore, PhDa, Jennifer Westaway, SRN, BSca, Hilliary Killer, RNb, Richard K. Firmin, FRCSa and Hitesh Pandya, MDa

a Department of Infection, Immunity and Inflammation, University of Leicester and Institute of Lung Health, Leicester, United Kingdom
b Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom

OBJECTIVE. 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.

METHODS. 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.

RESULTS. 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.

CONCLUSIONS. 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.

Key Words: lung function • meconium aspiration • diagnosis

Abbreviations: ECMO—extracorporeal membrane oxygenation • iNO—inhaled nitric oxide • FRCpleth—functional residual capacity measured by plethysmography • VmaxFRC—maximum expiratory flow at functional residual capacity • SGaw—specific airway conductance • SGawII—specific airway conductance during initial inspiration • RV-RTC—raised-volume rapid thoracic compression • FEVn—forced expiratory volume in n seconds • FVCp—forced vital capacity with applied pressure • tPTEF—time to peak tidal expiratory flow • tPTEF/te—ratio of tPTEF to expiratory time • CI—confidence interval • MAS—meconium aspiration • RDS—respiratory distress syndrome

Accepted Mar 3, 2007.


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