Published online December 8, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. e17-e24 (doi:10.1542/peds.2007-3566)

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ARTICLE

Medical and Financial Impact of a Neonatal Extracorporeal Membrane Oxygenation Referral Center in the Nitric Oxide Era

Theodore David Pawlik, MD, MBA^a, Nicolas Francisco Marcos Porta, MD^b, Robin Heise Steinhorn, MD^b, Edward Ogata, MD, MBA^b and Raye-Ann Odegaard deRegnier, MD^b

^a Northwest Newborn Specialists PC, Portland, Oregon
^b Division of Neonatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

OBJECTIVES. The primary objective of this study was to determine whether widespread use of nitric oxide after Food and Drug Administration approval decreased admissions to a neonatal referral center for extracorporeal membrane oxygenation evaluation. We also sought to determine whether antecedent treatment delayed eventual transfer, resulting in sicker patients, increased mortality, increased extracorporeal membrane oxygenation application, and higher direct costs of care.

METHODS. This was a retrospective cohort study of all of the patients transferred to a neonatal referral center for extracorporeal membrane oxygenation evaluation before (1995–1999) and after (2000–2005) Food and Drug Administration approval of nitric oxide. Patients were divided into "congenital diaphragmatic hernia" and "persistent pulmonary hypertension" (all other diagnoses) for additional analysis.

RESULTS. Admission rates for extracorporeal membrane oxygenation evaluation decreased in the nitric oxide era, and eventual transfer was not delayed. Persistent pulmonary hypertension patients had improved oxygen indexes, a trend toward decreased mortality, decreased extracorporeal membrane oxygenation use, and decreased direct costs. Congenital diaphragmatic hernia patients had unchanged physiologic measurements, mortality, and extracorporeal membrane oxygenation use with increased direct costs of care. As a whole, outcomes for patients transferred for extracorporeal membrane oxygenation evaluation improved, whereas direct costs were unchanged.

CONCLUSIONS. Persistent pulmonary hypertension patients had improved outcomes with decreased costs, whereas congenital diaphragmatic hernia patients had unchanged outcomes with increased costs. Overall, patients admitted to this NICU because of the presence of extracorporeal membrane oxygenation services had improved outcomes without increased costs in the nitric oxide era.

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Key Words: extracorporeal membrane oxygenation • health care costs • hernia • diaphragmatic • ICU • neonatal • meconium aspiration syndrome • nitric oxide • persistent fetal circulation syndrome • referral and consultation

Abbreviations: HRF—hypoxemic respiratory failure • ECMO—extracorporeal membrane oxygenation • HFOV—high-frequency oscillatory ventilation • iNO—inhaled nitric oxide • FDA—Food and Drug Administration • CMH—Children's Memorial Hospital • CDH—congenital diaphragmatic hernia • PPHN—persistent pulmonary hypertension • SNAPPE II—Score for Neonatal Acute Physiology With Perinatal Extension • OI—oxygenation index • LOS—length of stay

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Accepted Oct 8, 2008.

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