RISK-FACTORS FOR BRONCHOPULMONARY DYSPLASIA AFTER EXTRACORPOREAL MEMBRANE-OXYGENATION

Objective: To determine risk factors for the development of bronchopulmonary dysplasia (BPD) after treatment with extracorporeal membrane oxygenation (ECMO) Design: Retrospective case-control study. Setting: Tertiary care level 3 neonatal intensive care unit. Participants: Seventy-three newborns treated with ECMO for severe respiratory failure during a 5-year period, who survived until day of life 28, and who did not have pulmonary hypoplasia as the initial cause for respiratory failure. Interventions: None. Main Outcome Measure: The presence of BPD after treatment with ECMO, which was defined as oxygen and/or ventilatory requirements at day of life 28, with characteristic abnormalities seen on chest x-ray film. Results: The age at ECMO initiation was significantly greater for patients with BPD compared with patients without BPD (mean+/-SD, 135+/-68 hours vs 50+/-37 hours; P<.001). There was an 11.5-fold increased risk for the development of BPD if ECMO was initiated at greater than 96 hours of age. The primary diagnosis of respiratory distress syndrome imparted a 5.2-fold increased risk for the development of BPD. Patients with BPD required ECMO significantly longer than patients without BPD (203+/-73 hours vs 122+/-51 hours; P<.001). Conclusion: These results demonstrate that delayed use of ECMO in treating neonatal respiratory failure is associated with an increased risk for the development of BPD and a longer duration of ECMO therapy.