THE EFFICACY OF EXTRACORPOREAL LIFE-SUPPORT IN PREMATURE AND LOW-BIRTH-WEIGHT NEWBORNS

Based on data obtained early in the development of neonatal extracorporeal life support (ECLS), contraindications to the use of ECLS have included low estimated gestational age (EGA) and low birth weight (BW). However, multiple improvements in the technical and management aspects of neonatal ECLS have been implemented since those early data were evaluated. The purpose of this study, therefore, is to assess in the "modern era" the efficacy of prolonged extracorporeal support in premature and low birth weight newborns. Examination of the Extracorporeal Life Support Organization (ELSO) Registry showed that between 1988 and 1991 ECLS was utilized in 158 premature (PREM, EGA <-34 weeks), 4,128 full-term (FT, EGA>-35 weeks), 26 low birth weight (LBW, BW<2.0 kg), and 4,333 normal birth weight (NBW, BW >-2.0 kg) patients with respiratory failure. Data were evaluated for variables thought to be associated with a decrease in survival or an increase in the incidence of intracranial hemorrhage (ICH). A logistic regression model was developed to evaluate the ability of EGA and BW to predict survival. The incidence of survival (SURV) was decreased (63% v 84%) and ICH increased (37% v 14%) significantly in PREM when compared with FT newborns (P<.001). However, respectable survival rates in PREM patients with EGA>32 weeks were documented. In addition, both survival and ICH in PREM patients have improved substantially when compared with past reports (Past: SURV=25% and ICH=100%; current; SURV=63% and ICH=37%; ICH P<.001; SURV P=.056). Survival was significantly decreased in LBW when compared to NBW neonates (65% v 83%, P<.05), but there was no significant difference in ICH. The model demonstrated that EGA was, but that BW was not, an independent predictor of outcome. We conclude that respectable survival rates may be achieved in moribund PREM or LBW newborns supported with ECLS with an EGA>32 weeks. BW should not be considered as an independent exclusion criteria for ECLS. The incidence of ICH in PREM neonates has decreased, but is still significantly increased when compared to the rate in FT newborns. Earlier application of ECLS and further manipulations to reduce the incidence of ICH in premature patients may allow improvement in overall survival and wider application of ECLS in the premature and low BW population with respiratory failure. © 1993 W.B. Saunders Company. All rights reserved.