Texas Children's Fetal Center and the Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
J Surg Res. 2012 Oct;177(2):263-7. doi: 10.1016/j.jss.2012.07.058. Epub 2012 Aug 10.
Despite improvements in the management of persistent pulmonary hypertension of the newborn (PPHN), a number of infants with inadequate gas exchange are treated with extracorporeal membrane oxygenation (ECMO). The objectives of this study were to use the Extracorporeal Life Support Organization Registry to review the outcomes of neonates with PPHN receiving ECMO, and to identify pre-ECMO variables that may be associated with increased mortality.
The study is a retrospective analysis of all patients with PPHN supported with ECMO and reported to the Extracorporeal Life Support Organization registry from 2000 to 2010. Prematurity was defined as <37 wk gestation. Univariate analysis was performed using Student's t-test or Fisher's exact test. Variables found to be statistically significant underwent multivariate analysis by logistic regression. Kaplan-Meier survival curves were generated to analyze the relationship between duration of ECMO support and patient survival.
A total of 1569 neonates with PPHN received ECMO support during the study period, at an average age of 3.1 d of life and for a duration of 6.9 d. Survival among neonates with PPHN receiving ECMO support was 81%, and those receiving support for 7, 10, 14, and 21 d survived at rates of 88%, 78%, 55%, and 25%, respectively. By logistic regression, prematurity (P < 0.01), pre-ECMO pH ≤7.2 (P = 0.02), pre-ECMO SaO(2) ≤65% (P = 0.01), and duration of ECMO ≥7 d (P < 0.001) were independent predictors of death in this group. An average of 2.2 complications occurred per patient, with cardiovascular, mechanical, and renal complications being the most common.
Neonates with PPHN have high survival rates with ECMO support. Prematurity, acidosis, and profound hypoxemia are independently associated with increased mortality. Furthermore, prolonged ECMO support (>7 d) is associated with a higher risk of mortality in this cohort than in patients supported for <1 wk.
尽管新生儿持续性肺动脉高压（PPHN）的治疗已有改善，但仍有许多气体交换不足的婴儿需要接受体外膜氧合（ECMO）治疗。本研究的目的是使用体外生命支持组织登记处（Extracorporeal Life Support Organization Registry）回顾接受 ECMO 治疗的 PPHN 新生儿的结局，并确定可能与死亡率增加相关的 ECMO 前变量。
该研究是对 2000 年至 2010 年期间向体外生命支持组织登记处报告的所有接受 ECMO 支持的 PPHN 患者进行的回顾性分析。早产儿定义为<37 周妊娠。使用学生 t 检验或 Fisher 确切检验进行单变量分析。对具有统计学意义的变量进行多变量分析，采用逻辑回归。生成 Kaplan-Meier 生存曲线以分析 ECMO 支持持续时间与患者生存之间的关系。
在研究期间，共有 1569 例 PPHN 新生儿接受 ECMO 支持，平均年龄为 3.1 天，持续时间为 6.9 天。接受 ECMO 支持的 PPHN 新生儿的存活率为 81%，接受 7、10、14 和 21 天支持的患者的存活率分别为 88%、78%、55%和 25%。通过逻辑回归，早产儿（P<0.01）、ECMO 前 pH 值≤7.2（P=0.02）、ECMO 前 SaO2≤65%（P=0.01）和 ECMO 持续时间≥7 天（P<0.001）是该组死亡的独立预测因素。平均每位患者发生 2.2 种并发症，心血管、机械和肾脏并发症最常见。
接受 ECMO 支持的 PPHN 新生儿存活率较高。早产儿、酸中毒和严重低氧血症与死亡率增加独立相关。此外，与支持时间<1 周的患者相比，ECMO 支持时间延长（>7 天）与该队列患者的死亡率升高相关。
