Cannulating the contraindicated: effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation

Patrick T. Delaplain, Lishi Zhang, Yanjun Chen, Danh V. Nguyen, Matteo Di Nardo, John Patrick Cleary, Peter T. Yu, Yigit S. Guner

Research output: Contribution to journalArticlepeer-review

Abstract

Background/purpose Restrictions for ECMO in neonates include birth weight less than 2 kg (BW < 2 kg) and/or gestational age less than 34 weeks (GA < 34 weeks). We sought to describe their relationship on mortality. Methods Neonates with a primary diagnosis code of CDH were identified in the Extracorporeal Life Support Organization (ELSO) registry, and logistic regression models were used to examine the effect of BW < 2 kg and GA < 34 weeks on mortality. Results We identified 7564 neonates with CDH. The overall mortality was 50%. There was a significantly higher risk of death with unadjusted odds ratio (OR) 2.39 (95% confidence interval [CI]: 1.53–3.74; P < 0.01) for BW < 2 kg neonates. The adjusted OR of death for BW < 2 kg neonates remained significantly high with over two-fold increase in the odds of mortality when adjusted for potential confounding variables (OR 2.11, 95% CI: 1.30–3.43; P < 0.01). However, no difference in mortality was observed in neonates with GA < 34 weeks. Conclusions While mortality among CDH neonates with a BW < 2 kg was substantially increased, GA < 34 weeks was not significantly associated with mortality. Effort should be made to identify the best candidates for ECMO in this high-risk group and develop treatment strategies to optimize their survival. Type of study Case–Control Study, Retrospective Comparative Study. Level of evidence Level III.

Original languageEnglish
Pages (from-to)2018-2025
Number of pages8
JournalJournal of Pediatric Surgery
Volume52
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

Keywords

  • CDH
  • ECMO
  • Low birthweight
  • Low gestation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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