From the Division of Neonatology, Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
ASAIO J. 2022 Jun 1;68(6):e106-e109. doi: 10.1097/MAT.0000000000001520. Epub 2022 Jul 15.
Pulmonary hemorrhage (PH) is an infrequent and potentially fatal event in term neonates. Reports of successful management of PH on extracorporeal membrane oxygenation (ECMO) are limited, given the accentuated risk of mortality imposed by the use of heparin to prevent thrombosis on ECMO. We present a case of a term neonate with hypoxic ischemic encephalopathy undergoing controlled hypothermia who developed hypoxic respiratory failure, hemodynamic instability, Enterobacter cloacae pneumonia and sepsis complicated by severe PH who required support with veno-arterial ECMO. We describe the therapeutic strategies used on veno-arterial ECMO to successfully manage this infant, including clamping the endotracheal tube, aggressive correction of coagulopathy, and use of dornase alfa, as well as elaborate on the subtle changes in ECMO parameters during the run that preceded worsening pneumonia with sepsis.
肺出血（PH）是足月儿中一种罕见且潜在致命的事件。由于在体外膜氧合（ECMO）上使用肝素以防止血栓形成而增加了死亡率，因此，关于 ECMO 成功管理 PH 的报道有限。我们报告了一例患有缺氧缺血性脑病并接受控制性低温治疗的足月新生儿，该新生儿发生了低氧性呼吸衰竭、血流动力学不稳定、阴沟肠杆菌肺炎和败血症，并发严重 PH，需要静脉-动脉 ECMO 支持。我们描述了在静脉-动脉 ECMO 上使用的治疗策略，成功地管理了这名婴儿，包括夹闭气管内管、积极纠正凝血功能障碍以及使用脱氧核糖核酸酶阿尔法，以及详细阐述了在发生伴有败血症的肺炎恶化之前，ECMO 参数在运行过程中的细微变化。
