The decision regarding whether or not an infant required supplemental oxygen was based on arterial blood gas values, correlated with a tc02 measurement, obtained prior to discharge from the NICU. This allowed us to detect any drop in Pa02 during arterial puncture. Supplemental oxygen was continued if the Pa02 was less than 70 mm Hg while the infant was breathing room air at rest. Pulmonary medications were prescribed by the primary pediatrician assigned to follow the patient based on clinical assessment. This decision was made independent of the research studies performed.
Materials and Methods
We studied 19 infants who were seen for the routine six-month follow-up evaluation at Childrens Hospital of Los Angeles. These infants were treated with ECMO for severe neonatal respiratory failure. Infants with congenital diaphragmatic hernia and congenital heart defects were excluded from this study. Severe neonatal respiratory failure was defined as a risk of greater than an 80 percent mortality with the use of conventional mechanical ventilation. This criterion for >80 percent mortality was based on a three-year retrospective study at our institution. All infants met one or more of the three following criteria for ECMO:
1. MAP >18 cm H20, Flo* 1.0 dynes*s*cm‘, and Pa02 <50 mm Hg.
2. OI >40 for 2 h (OI = MAP x Flo/PaO*).
3. Single OI >40 with radiographic evidence of severe barotrauma.
The presence of pulmonary sequelae has been demonstrated in the survivors of RDS and meconium aspiration syndrome. Lung injury during the newborn period from supplemental oxygen or assisted mechanical ventilation or both also are believed to cause chronic lung disease.- Extracorporeal membrane oxygenation often is used as life-saving therapy for neonates with reversible respiratory failure and a high mortality risk with conventional management; EC MO consists of prolonged cardiopulmonary bypass while resting the lungs and using minimal ventilator settings. It is hypothesized that this promotes lung healing and prevents further injury from high oxygen concentration and barotrauma.