Cicalese Erin, Seltzer Bryn H S, Fisher Jason C, Verma Sourabh
Division of Neonatology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone, New York University Grossman School of Medicine, New York, New York.
Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York University Grossman School of Medicine, New York, New York.
Am J Perinatol. 2025 Aug;42(11):1409-1415. doi: 10.1055/a-2499-4712. Epub 2024 Dec 11.
This study aimed to examine survival and outcomes in neonates who received therapeutic hypothermia (TH) for neonatal encephalopathy (NE) and extracorporeal membrane oxygenation (ECMO) versus ECMO alone.This is a retrospective review of Extracorporeal Life Support Organization (ELSO) Registry data from 2007 to 2017 for neonates undergoing ECMO and TH for NE (TH/ECMO) or ECMO alone. Primary outcomes were ECMO survival and survival to discharge. Secondary outcomes were complications while on ECMO. Statistical analysis was performed using Fisher's exact and Mann-Whitney U tests. Multivariate regression was performed to identify predictors of ECMO survival.Of 3,672 neonates, 215 (6%) received TH/ECMO, while 3,457 (94%) received ECMO alone. There was no significant difference in ECMO survival (92 vs. 92%, = 0.70) or survival to discharge (87 vs. 85%, = 0.43) between groups. TH/ECMO group had higher hemorrhagic (29 vs. 20%, < 0.01), neurologic (24% vs. 12%, < 0.01), and metabolic (28 vs. 15%, < 0.01) complications. Multivariate regression identified higher gestational age, absence of inotropes during ECMO, and lack of neurologic, pulmonary, or hemorrhagic complications as independent predictors of ECMO survival.Neonates undergoing ECMO and TH for NE had survival rates comparable to those receiving ECMO alone. These findings suggest that ECMO can be considered for neonates with NE undergoing TH who meet the criteria for ECMO. · ECMO survival is comparable between neonates who underwent TH and ECMO versus ECMO alone.. · Neonates who underwent TH and ECMO had more hemorrhagic, neurologic, and metabolic complications.. · Offering ECMO to qualifying neonates also undergoing TH is reasonable..
本研究旨在探讨接受治疗性低温（TH）联合体外膜肺氧合（ECMO）治疗新生儿脑病（NE）的新生儿与仅接受ECMO治疗的新生儿的生存情况和预后。这是一项对体外生命支持组织（ELSO）2007年至2017年登记数据的回顾性研究，研究对象为接受ECMO和TH治疗NE（TH/ECMO）或仅接受ECMO治疗的新生儿。主要结局是ECMO存活和出院存活。次要结局是ECMO治疗期间的并发症。采用Fisher精确检验和Mann-Whitney U检验进行统计分析。进行多变量回归以确定ECMO存活的预测因素。在3672例新生儿中，215例（6%）接受TH/ECMO治疗，而3457例（94%）仅接受ECMO治疗。两组之间在ECMO存活（92%对92%，P = 0.70）或出院存活（87%对85%，P = 0.43）方面无显著差异。TH/ECMO组有更高的出血（29%对20%，P < 0.01）、神经（24%对12%，P < 0.01）和代谢（28%对15%，P < 0.01）并发症。多变量回归确定较高的胎龄、ECMO期间未使用血管活性药物以及无神经、肺部或出血并发症是ECMO存活的独立预测因素。接受ECMO和TH治疗NE的新生儿的存活率与仅接受ECMO治疗的新生儿相当。这些发现表明，对于符合ECMO标准且正在接受TH治疗的NE新生儿可考虑使用ECMO。· 接受TH和ECMO治疗的新生儿与仅接受ECMO治疗的新生儿的ECMO存活率相当。· 接受TH和ECMO治疗的新生儿有更多的出血、神经和代谢并发症。· 为符合条件且正在接受TH治疗的新生儿提供ECMO是合理的。
