Bacterial and fungal infection in neonates undergoing venoarterial extracorporeal membrane oxygenation: An analysis of the registry data of the extracorporeal life support organization

A review and analysis of 5,001 neonatal venoarterial (VA) extracorporeal membrane oxygenation (ECMO) cases showed that bacterial and fungal infection occurred in 147 (2.9%) and 26 (0.6%) patients, respectively, with an overall incidence of 3.5%. Bivariate analysis was used to compare infected infants with controls, bacterial versus fungal groups, and bacterial subgroups with respect to patient demographics, primary diagnosis, mechanical complications, patient complications, duration of the ECMO course, and hospital mortality. Logistic regression models were constructed using variables that were statistically significant from the bivariate comparisons. Variables that remained significant after multivariate analysis included primary diagnosis of pneumonia/sepsis, mechanical complications of oxygenator failure, rupture of raceway or tubing, clots, and patient complications of hypertension and hyperbilirubinemia. The infection group had significantly longer mean total hours on bypass and higher hospital mortality. Infants with fungal infection had a significantly higher hospital mortality rate compared with those with bacterial infection. We conclude that infection during ECMO, especially fungal infection, carries an increased risk of hospital mortality and that mechanical complications are associated with an increased risk of infection.