Predictability model of the need for extracorporeal membrane oxygenation in neonates with meconium aspiration syndrome treated with inhaled nitric oxide

Friedlich, Philippe; Noori, Shahab; Stein, James; Shin, Cathy; Burns, Cartland; Ramanathan, Rangansamy; Seri, Istvan

doi:10.1016/j.jpedsurg.2005.03.061

« Previous Next »Journal of Pediatric Surgery
Volume 40, Issue 7 , Pages 1090-1093, July 2005

Predictability model of the need for extracorporeal membrane oxygenation in neonates with meconium aspiration syndrome treated with inhaled nitric oxide

Philippe Friedlich
- USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, CA 90027, USA
- Women's and Children's Hospital, LAC+USC Medical Center, Los Angeles, CA 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Corresponding author. Division of Neonatology, Department of Pediatrics, Childrens Hospital Los Angeles, Los Angeles, CA 90027, USA. Tel.: +1 323 669 5932; fax: +1 323 668 7927.
Shahab Noori
- USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, CA 90027, USA
- Women's and Children's Hospital, LAC+USC Medical Center, Los Angeles, CA 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
James Stein
- Department of Pediatric Surgery, Childrens Hospital Los Angeles, CA 90027, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Cathy Shin
- Department of Pediatric Surgery, Childrens Hospital Los Angeles, CA 90027, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Cartland Burns
- Department of Pediatric Surgery, Childrens Hospital Los Angeles, CA 90027, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Rangansamy Ramanathan
- USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, CA 90027, USA
- Women's and Children's Hospital, LAC+USC Medical Center, Los Angeles, CA 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
Istvan Seri
- USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, CA 90027, USA
- Women's and Children's Hospital, LAC+USC Medical Center, Los Angeles, CA 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA

Abstract

Background

As the use of inhaled nitric oxide (iNO) resulted in a decline in the need for extracorporeal membrane oxygenation (ECMO) in neonates with hypoxic respiratory failure, iNO has become an accepted treatment modality even in non-ECMO centers. However, because not all neonates respond to iNO, the timely identification and transfer of nonresponders to an ECMO center are important.

Objectives

The objective of this study was to identify the risk factors predictive of the need of ECMO in neonates with hypoxic respiratory failure after the first 6 hours of iNO treatment in an ECMO center.

Methods and Patient Population

Forty-nine patients with hypoxic respiratory failure transferred for iNO therapy and potential ECMO during a 2-year period were identified in this retrospective study. None of the patients had received iNO before admission. Strict clinical guidelines were used to standardize lung inflation, cardiovascular support, and iNO administration and weaning and to define treatment failure. The relationship between treatment failure (ie, the need for ECMO) and a set of suspected risk factors after 6 hours of iNO administration was examined by logistic regression analysis.

Results

Twenty-two neonates responded to iNO (non-ECMO group) whereas 27 neonates failed and met ECMO criteria (ECMO group). There was no difference between the 2 groups in demographic data, ventilatory support, air leak syndrome at 6 hours of iNO treatment, and survival to discharge. However, the dose and duration of iNO therapy were predictive of the need for ECMO with an adjusted odds ratio of 1.12 (95% CI, 1.01-1.25; P = .04) and 0.45 (95% CI, 0.27-0.65; P = .0002), respectively.

Conclusions

By the end of the first 6 hours of iNO treatment and under the specific conditions established by the use of the clinical guidelines, the dose and the duration of iNO administration were predictive of the probability for the need of ECMO in this patient population. Thus, one can establish a center-specific predictability model for the need of ECMO in neonates with hypoxic respiratory failure treated with iNO if strict clinical guidelines for iNO administration and weaning and respiratory and cardiovascular support are used in the given center.