1
|
Gehle DB, Meyer LC, Jancelewicz T. The role of extracorporeal life support and timing of repair in infants with congenital diaphragmatic hernia. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000752. [PMID: 38645885 PMCID: PMC11029407 DOI: 10.1136/wjps-2023-000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Extracorporeal life support (ECLS) serves as a rescue therapy for patients with congenital diaphragmatic hernia (CDH) and severe cardiopulmonary failure, and only half of these patients survive to discharge. This costly intervention has a significant complication risk and is reserved for patients with the most severe disease physiology refractory to maximal cardiopulmonary support. Some contraindications to ECLS do exist such as coagulopathy, lethal chromosomal or congenital anomaly, very preterm birth, or very low birth weight, but many of these limits are being evaluated through further research. Consensus guidelines from the past decade vary in recommendations for ECLS use in patients with CDH but this therapy appears to have a survival benefit in the most severe subset of patients. Improved outcomes have been observed for patients treated at high-volume centers. This review details the evolving literature surrounding management paradigms for timing of CDH repair for patients receiving preoperative ECLS. Most recent data support early repair following cannulation to avoid non-repair which is uniformly fatal in this population. Longer ECLS runs are associated with decreased survival, and patient physiology should guide ECLS weaning and eventual decannulation rather than limiting patients to arbitrary run lengths. Standardization of care across centers is a major focus to limit unnecessary costs and improve short-term and long-term outcomes for these complex patients.
Collapse
Affiliation(s)
- Daniel B Gehle
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Logan C Meyer
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tim Jancelewicz
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
2
|
Bo BBL, Lemloh L, Hale L, Heydweiller A, Strizek B, Bendixen C, Schroeder L, Mueller A, Kipfmueller F. [Characteristics and Outcome of Neonates With Postnatally Diagnosed Congenital Diaphragmatic Hernia]. Z Geburtshilfe Neonatol 2024; 228:181-187. [PMID: 38101444 DOI: 10.1055/a-2198-8950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) is one of the most severe neonatal malformations with a mortality of 20-35%. Currently, the rate of prenatally recognized CDHs is 60-80%. This study investigated the characteristics and outcome data of children with prenatally unrecognized CDH. METHODS Postnatally diagnosed CDH newborns treated at the University Hospital Bonn between 2012 and 2021 were included. Treatment and outcome data were compared according to type of maternity hospital, Apgar values, and between prenatally and postnatally diagnosed CDH. RESULTS Of 244 CDH newborns, 22 were included. Comparison for birth in a facility with vs. without pediatric care showed for mortality: 9% vs. 27%, p=0.478; ECMO rate: 9% vs. 36%, p=0.300; age at diagnosis: 84 vs. 129 min, p=0.049; time between intubation and diagnosis: 20 vs. 86 min, p=0.019. Newborns in the second group showed significantly worse values for pH and pCO2. Furthermore, there was a tendency for higher mortality and ECMO rates in children with an Apgar score<7 vs.≥7. Children diagnosed postnatally were significantly more likely to have moderate or severe PH and tended to have cardiac dysfunction more often than those diagnosed prenatally. DISCUSSION In our cohort, ca. one in 10 newborns received a postnatal CDH diagnosis. Birth in a facility without pediatric care is associated with later diagnosis, which may favor hypercapnia/acidosis and more severe pulm. HYPERTENSION
Collapse
Affiliation(s)
- Bartolomeo B L Bo
- Abteilung Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Lotte Lemloh
- Abteilung Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Lennart Hale
- Abteilung Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Brigitte Strizek
- Abteilung Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Lukas Schroeder
- Abteilung Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Andreas Mueller
- Abteilung Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Florian Kipfmueller
- Abteilung Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| |
Collapse
|
3
|
Wegele C, Schreiner Y, Perez Ortiz A, Hetjens S, Otto C, Boettcher M, Schaible T, Rafat N. Impact of Time Point of Extracorporeal Membrane Oxygenation on Mortality and Morbidity in Congenital Diaphragmatic Hernia: A Single-Center Case Series. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070986. [PMID: 35883970 PMCID: PMC9315500 DOI: 10.3390/children9070986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
Since there are no data available on the influence of the time point of ECMO initiation on morbidity and mortality in patients with congenital diaphragmatic hernia (CDH), we investigated whether early initiation of ECMO after birth is associated with a beneficial outcome in severe forms of CDH. All neonates with CDH admitted to our institution between 2010 until 2020 and undergoing ECMO treatment were included in this study and divided into four different groups: (1) ECMO initiation < 12 h after birth (n = 143), (2) ECMO initiation between 12−24 h after birth (n = 31), (3) ECMO initiation between 24−120 h after birth (n = 48) and (4) ECMO initiation > 120 h after birth (n = 14). The mortality rate in the first (34%) and fourth group (43%) was high and in the second group (23%) and third group (12%) rather low. The morbidity, characterized by chronic lung disease (CLD), did not differ significantly in the three groups; only patients in which ECMO was initiated >120 h after birth had an increased rate of severe CLD. Our data, although not randomized and limited due to small study groups, suggest that very early need for ECMO and ECMO initiation > 120 h after birth is associated with increased mortality.
Collapse
Affiliation(s)
- Christian Wegele
- Department of Neonatology, University Children’s Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (C.W.); (Y.S.); (A.P.O.); (T.S.)
- Department of Neonatology, Pediatric Intensive Care and Sleep Medicine, Vestische Kinder-Jugendklinik Datteln, University Witten/Herdecke, 45711 Datteln, Germany
| | - Yannick Schreiner
- Department of Neonatology, University Children’s Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (C.W.); (Y.S.); (A.P.O.); (T.S.)
| | - Alba Perez Ortiz
- Department of Neonatology, University Children’s Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (C.W.); (Y.S.); (A.P.O.); (T.S.)
| | - Svetlana Hetjens
- Department of Biomathematics and Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Christiane Otto
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Michael Boettcher
- Department of Pediatric Surgery, University Children’s Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Thomas Schaible
- Department of Neonatology, University Children’s Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (C.W.); (Y.S.); (A.P.O.); (T.S.)
| | - Neysan Rafat
- Department of Neonatology, University Children’s Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (C.W.); (Y.S.); (A.P.O.); (T.S.)
- Correspondence: ; Tel.: +49-(0)621-383-3510
| |
Collapse
|
4
|
Choi W, Cho WC, Choi ES, Yun TJ, Park CS. Outcomes after Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Single-Center Experience. J Chest Surg 2021; 54:348-355. [PMID: 34611083 PMCID: PMC8548188 DOI: 10.5090/jcs.21.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Congenital diaphragmatic hernia (CDH) is a rare disease often requiring mechanical ventilation after birth. In severe cases, extracorporeal membrane oxygenation (ECMO) may be needed. This study analyzed the outcomes of patients with CDH treated with ECMO and investigated factors related to in-hospital mortality. Methods Among 254 newborns diagnosed with CDH between 2008 and 2020, 51 patients needed ECMO support. At Asan Medical Center, a multidisciplinary team approach has been applied for managing newborns with CDH since 2018. Outcomes were compared between hospital survivors and nonsurvivors. Results ECMO was established at a median of 17 hours after birth. The mean birth weight was 3.1±0.5 kg. Twenty-three patients (23/51, 45.1%) were weaned from ECMO, and 16 patients (16/51, 31.4%) survived to discharge. The ECMO mode was veno-venous in 24 patients (47.1%) and veno-arterial in 27 patients (52.9%). Most cannulations (50/51, 98%) were accomplished through a transverse cervical incision. No significant between-group differences in baseline characteristics and prenatal indices were observed. The oxygenation index (1 hour before 90.0 vs. 51.0, p=0.005) and blood lactate level (peak 7.9 vs. 5.2 mmol/L, p=0.023) before ECMO were higher in nonsurvivors. Major bleeding during ECMO more frequently occurred in nonsurvivors (57.1% vs. 12.5%, p=0.007). In the multivariate analysis, the oxygenation index measured at 1 hour before ECMO initiation was identified as a significant risk factor for in-hospital mortality (odds ratio, 1.02; 95% confidence interval, 1.01–1.04; p=0.05). Conclusion The survival of neonates after ECMO for CDH is suboptimal. Timely application of ECMO is crucial for better survival outcomes.
Collapse
Affiliation(s)
- Wooseok Choi
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Chul Cho
- Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Amodeo I, Di Nardo M, Raffaeli G, Kamel S, Macchini F, Amodeo A, Mosca F, Cavallaro G. Neonatal respiratory and cardiac ECMO in Europe. Eur J Pediatr 2021; 180:1675-1692. [PMID: 33547504 PMCID: PMC7864623 DOI: 10.1007/s00431-020-03898-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
Neonatal extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for critically ill neonates suffering from a potentially reversible disease, causing severe cardiac and/or respiratory failure and refractory to maximal conventional management. Since the 1970s, technology, management, and clinical applications of neonatal ECMO have changed. Pulmonary diseases still represent the principal neonatal diagnosis, with an overall 74% survival rate, and up to one-third of cases are due to congenital diaphragmatic hernia. The overall survival rate in cardiac ECMO is lower, with congenital heart defect representing the main indication. This review provides an overview of the available evidence in the field of neonatal ECMO. We will address the changing epidemiology, basic principles, technologic advances in circuitry, and monitoring, and deliver a current multidisciplinary management framework, focusing on ECMO applications, complications, and long-term morbidities. Lastly, areas for further research will be highlighted.Conclusions: ECMO is a life support with a potential impact on long-term patients' outcomes. In the next years, advances in knowledge, technology, and expertise may push neonatal ECMO boundaries towards more premature and increasingly complex infants, with the final aim to reduce the burden of ECMO-related complications and improve overall patients' outcomes. What is Known: • ECMO is a life-saving option in newborns with refractory respiratory and/or cardiac failure. • The multidisciplinary ECMO management is challenging and may expose neonates to complications with an impact on long-term outcomes. What is New: • Advances in technology and biomaterials will improve neonatal ECMO management and, eventually, the long-term outcome of these complex patients. • Experimental models of artificial placenta and womb technology are under investigation and may provide clinical translation and future research opportunities.
Collapse
Affiliation(s)
- Ilaria Amodeo
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | | | - Genny Raffaeli
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Shady Kamel
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
- Betamed Perfusion Service, Rome, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Amodeo
- ECMO & VAD Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| |
Collapse
|
6
|
Das S, Gupta S, Das D, Dutta N. Basics of extra corporeal membrane oxygenation: a pediatric intensivist's perspective. Perfusion 2021; 37:439-455. [PMID: 33765881 DOI: 10.1177/02676591211005260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extra Corporeal membrane oxygenation (ECMO) is one of the most advanced forms of life support therapy in the Intensive Care Unit. It relies on the principle where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) within which blood becomes enriched with oxygen and has carbon dioxide removed. The blood is then returned to the patient via a central vein or an artery. The goal of ECMO is to provide a physiologic milieu for recovery in refractory cardiac/respiratory failure. The technology is not a definitive treatment for a disease, but provides valuable time for the body to recover. In that way it can be compared to a bridge, where patients are initiated on ECMO as a bridge to recovery, bridge to decision making, bridge to transplant or bridge to diagnosis. The use of this modality in children is not backed by a lot of randomized controlled trials, but the use has increased dramatically in our country in last 10 years. This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
Collapse
Affiliation(s)
- Shubhadeep Das
- Department of Pediatric Cardiac Intensive Care, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Sandip Gupta
- Department of Pediatric Intensive Care, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Debasis Das
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Nilanjan Dutta
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| |
Collapse
|
7
|
Balks J, Mueller A, Herberg U, Geipel A, Gembruch U, Schroeder L, Dewald O, Breuer J, Weidenbach M, Berg C, Kipfmueller F. [Therapy and Outcome of Neonates with Congenital Diaphragmatic Hernia and Congenital Heart Defects]. Z Geburtshilfe Neonatol 2021; 225:432-440. [PMID: 33694149 DOI: 10.1055/a-1392-1460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Die Mortalität von Patienten mit isoliert auftretenden angeborenen Zwerchfellhernien liegt in spezialisierten Zentren bei 20-40%. Wesentliche, das Outcome beeinflussende Faktoren, sind die bestehende Lungenhypoplasie, eine daraus resultierende pulmonale Hypertonie, sowie das Vorliegen weiterer Fehlbildungen. Begleitfehlbildungen wie angeborene Herzfehler treten bei ca. 18% aller Neonaten mit Zwerchfellhernie auf. Schwere angeborene Herzfehler wie das hypoplastische Linksherz Syndrom zeigen sich in ca. 8% der Fälle. In einer retrospektiven Analyse des Patientenkollektivs unserer Klinik zwischen 01/2012 und 12/2018 wurde das prä- und postnatale Management, sowie das Outcome von Neugeborenen mit der Kombination aus angeborenen Herzfehlern und Zwerchfellhernien untersucht. Im Studienzeitraum wurden in unserer Klinik 156 Neugeborene mit Zwerchfellhernie behandelt. Bei 10 Patienten (6,4%) lag zusätzlich ein schwerer, bei 11 Patienten (7,1%) ein moderater Herzfehler vor. 6/21 Patienten verstarben im Verlauf des Krankenhausaufenthaltes, davon 3 am ersten Lebenstag. Es zeigte sich eine deutlich geringere Mortalität bei Patienten mit Zwerchfellhernie und moderatem Herzfehler im Vergleich zu schwerem Herzfehler (9 vs. 50%). Besonders hoch lag die Mortalität bei Kindern mit einem univentrikulären Herzen. Trotz einer deutlich reduzierten Prognose bei der Kombination aus angeborenem Herzfehler und Zwerchfellhernie muss nicht generell mit einer infausten Prognose gerechnet werden. In spezialisierten Zentren kann ein kurativer Ansatz erfolgen.The mortality of patients with isolated congenital diaphragmatic hernia (CDH) in specialized centers is 20-40%. The main factors influencing the outcome are the underlying pulmonary hypoplasia, the resulting pulmonary hypertension and the presence of other malformations. Concomitant malformations such as congenital heart defects occur in around 18% of all neonates with a diaphragmatic hernia. Serious congenital heart defects such as hypoplastic left heart syndrome occur in approximately 8% of cases. In a retrospective analysis of the patient collective of our hospital between 01/2012 and 12/2018, the prenatal and postnatal management as well as the outcome of newborns with a combination of congenital heart defects and diaphragmatic hernias were examined. During the study period, 156 newborns with diaphragmatic hernias were treated at our institution. In 10 patients (6.4%) there was also a severe, and in 11 patients (7.1%) a moderate heart defect. 6/21 patients died during their hospital stay, 3 of them on the first day of life. There was a significantly lower mortality in patients with diaphragmatic hernia and moderate heart defects compared to severe heart defects (9 vs. 50%). The mortality in children with a univentricular heart was particularly high. Despite a significantly reduced prognosis for the combination of congenital heart defects and diaphragmatic hernia, generally a poor prognosis does not have to be expected. A curative approach can be achieved in specialized centers.
Collapse
Affiliation(s)
- Julian Balks
- Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Andreas Mueller
- Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Ulrike Herberg
- Abteilung für Kinderkardiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Annegret Geipel
- Abteilung Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Ulrich Gembruch
- Abteilung Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Lukas Schroeder
- Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Oliver Dewald
- Universitätsklinik für Herzchirurgie, Universitätsklinikum Oldenburg, Oldenberg, Deutschland
| | - Johannes Breuer
- Abteilung für Kinderkardiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Michael Weidenbach
- Herzzentrum Leipzig, Kinderkardiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christoph Berg
- Abteilung Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Florian Kipfmueller
- Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| |
Collapse
|
8
|
Cummins CB, Bowen-Jallow KA, Tran S, Radhakrishnan RS. Education of pediatric surgery residents over time: Examining 15 years of case logs. J Pediatr Surg 2021; 56:85-98. [PMID: 33139026 PMCID: PMC9618151 DOI: 10.1016/j.jpedsurg.2020.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND/PURPOSE Surgical indications and techniques have changed over the last 15 years. The number of Pediatric Surgery training programs has also increased. We sought to examine the effect of these changes on resident education by examining case log data. METHODS Accreditation Council for Graduate Medical Education (ACGME) case logs for graduating Pediatric Surgery residents were examined from 2004 to 2018. Using the summary statistics provided, linear regression analysis was conducted on each case log code and category. RESULTS In 2004, there were 24 Pediatric Surgery training programs and 24 Pediatric Surgery residents graduating with an average of 979.8 total cases logged. In 2018, there were 36 programs with 38 residents graduating with an average of 1260.2 total cases logged. Total case volume of graduating residents significantly increased over the last 15 years (p < 0.001). Significant increases were demonstrated in skin/soft tissue/musculoskeletal (p < 0.01), abdominal (p < 0.001), hernia repair (p < 0.001), genitourinary (p < 0.01), and endoscopy (p < 0.001). No significant changes were seen in the head and neck, thoracic, cardiovascular, liver/biliary, and non-operative trauma categories. No categories significantly decreased over the time period. No significant changes were seen in the number of multiple index congenital cases, including tracheoesophageal fistula/esophageal atresia repair, omphalocele, gastroschisis, choledochal cyst excision, perineal procedure for imperforate anus, and major hepatic resections for tumors. Pertinent increases in specific procedures include diaphragmatic hernia repair (p < 0.01), ECMO cannulation/decannulation(p < 0.05), thyroidectomy (p < 0.001), parathyroidectomy (p < 0.001), biliary atresia (p < 0.001), and circumcision (p < 0.001) as well as most laparoscopic abdominal procedures. Specific procedure codes with significant decreases include tracheostomy (p < 0.05), minimally invasive decortication/pleurectomy/blebectomy (p < 0.001), laparoscopic splenectomy (p < 0.001), as well as most open abdominal procedures. CONCLUSION Despite increasing numbers of Pediatric Surgery residents and training programs, the number of cases performed by each graduating resident has increased. This increase is primarily fueled by increase in abdominal, skin/soft tissue/musculoskeletal, hernia repair, genitourinary, and endoscopic cases. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Claire B. Cummins
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 75555-0353, USA
| | - Kanika A. Bowen-Jallow
- Division of Pediatric Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 75555-0353, USA
| | - Sifrance Tran
- Division of Pediatric Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 75555-0353, USA
| | - Ravi S. Radhakrishnan
- Division of Pediatric Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 75555-0353, USA
| |
Collapse
|
9
|
Cavallaro G, Di Nardo M, Hoskote A, Tibboel D. Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next? Front Pediatr 2021; 9:796670. [PMID: 35059363 PMCID: PMC8764394 DOI: 10.3389/fped.2021.796670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Aparna Hoskote
- Cardiorespiratory and Critical Care Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| |
Collapse
|
10
|
Heindel K, Holdenrieder S, Patel N, Bartmann P, Schroeder L, Berg C, Merz WM, Mueller A, Kipfmueller F. Early postnatal changes of circulating N-terminal-pro-B-type natriuretic peptide in neonates with congenital diaphragmatic hernia. Early Hum Dev 2020; 146:105049. [PMID: 32402829 DOI: 10.1016/j.earlhumdev.2020.105049] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Severity of lung hypoplasia, pulmonary hypertension (PH) and cardiac dysfunction are major contributors to mortality in congenital diaphragmatic hernia (CDH). Therefore, early assessment and management is important to improve outcome. NT-proBNP is an established cardiac biomarker with only limited data for early postnatal risk assessment in CDH newborns. AIMS To investigate the correlation of NT-proBNP at birth, 6 h, 12 h, 24 h, and 48 h with PH and cardiac dysfunction and the prognostic information of NT-proBNP for the use of ECMO support or mortality. SUBJECTS 44 CDH newborns treated at our institution (December 2014-October 2017) were prospectively enrolled. OUTCOME MEASURES Primary clinical endpoint was either need for ECMO or death within the first 48 h (group A). Infants not receiving ECMO support were allocated to group B. Mortality was tested as secondary endpoint. RESULTS NT-proBNP levels measured at 6 h, 12 h, 24 h and 48 h postpartum correlated significantly with PH severity following NICU admission and at 24 h, and with severity of cardiac dysfunction at birth, 24 h, 48 h and after 7 days of life. There was no difference in NT-proBNP levels between survivors and non-survivors. NT-proBNP levels were significantly higher in group A at 6 h (p = 0.007), 12 h (p = 0.036), and 24 h (p = 0.007), but not at birth (p = 0.785) or 48 h (p = 0.15) compared to group B. CONCLUSION NT-proBNP analysis in the first 48 h of life may be useful to assess PH and cardiac dysfunction in CDH newborns and to predict the need for ECMO support.
Collapse
Affiliation(s)
- Katrin Heindel
- Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Germany
| | - Stefan Holdenrieder
- Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany; Institute for Laboratory Medicine, German Heart Center of the State of Bavaria and the Technical University Munich, Germany
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, UK
| | - Peter Bartmann
- Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Germany
| | - Lukas Schroeder
- Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Germany
| | | | - Andreas Mueller
- Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Germany
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Germany.
| |
Collapse
|
11
|
Hong X, Zhao Z, Liu Z, Liu C, Wang J, Quan X, Wu H, Ji Q, Sun J, Cheng D, Feng Z, Shi Y. Venoarterial Extracorporeal Membrane Oxygenation for Severe Neonatal Acute Respiratory Distress Syndrome in a Developing Country. Front Pediatr 2020; 8:227. [PMID: 32548079 PMCID: PMC7270410 DOI: 10.3389/fped.2020.00227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/15/2020] [Indexed: 01/19/2023] Open
Abstract
Objective: Extracorporeal membrane oxygenation (ECMO) has supported oxygen delivery and carbon dioxide removal in neonatal severe respiratory failure for more than 4 decades. The definition and diagnosis of neonatal acute respiratory distress syndrome (ARDS) was made according to the criteria first established by a Montreux Conference in 2017. By far, there has been no ECMO efficiency studies in neonatal ARDS. We aimed to compare the outcomes of neonates with severe ARDS supported with and without ECMO. Design: Retrospective pair-matched study. Setting: In the present retrospective pair-matched study, the outcomes of severe ARDS with ECMO support and without ECMO support were analyzed and compared. Propensity score matching was conducted. The study subjects were selected from a China Neonatal ECMO (CNECMO) study. In total, five hospitals were included in the CNECMO study. The patients were matched with demographic and clinical data. The primary endpoint was in-hospital mortality. Secondary outcomes included ventilator-time, ICU stay, hospitalization costs and cranial MRI results. Patients: 145 neonates with severe ARDS (Oxygenation Index, OI ≥16) from 5 hospitals. Interventions: No interventions. Measurements and Main Results: We collected the data of 145 neonates with severe ARDS (Oxygenation Index, OI≥16) from 5 hospitals. Among them, 42 neonates received venoarterial (VA) ECMO support, and the remaining 103 neonates were treated with conventional mechanical ventilation. The mortality of ECMO-supported neonates was not significantly different compared with the ESLO neonatal respiratory-supported from 2012 to 2018 (23.8 vs. 32.5%, p = 0.230). After matching with the propensity score we got 31 pairs. The ECMO-supported neonates had a lower in-hospital mortality (6 of 31, 19.4%) vs. non ECMO-supported patients (18 of 31, 58.1%) (p = 0.002). Hospitalization costs of survivors in ECMO-supported neonates were significantly higher than that of non-ECMO-supported neonates (p < 0.001). There was no difference of ventilator-times (p = 0.206), ICU stay (p = 0.879) and cranial MRI (p = 0.899) between the survivors of ECMO-supported and non-ECMO-supported neonates with ARDS. Conclusions: By far, there has been no ECMO efficiency studies in neonatal ARDS. This study found that ECMO-support have superior outcomes compared with non-ECMO-support in neonates with severe ARDS.
Collapse
Affiliation(s)
- Xiaoyang Hong
- Pediatric Intensive Care Unit, Affiliated Bayi Children's Hospital, The Seventh Medical Center, PLA General Hospital, Beijing, China
| | - Zhe Zhao
- Pediatric Intensive Care Unit, Affiliated Bayi Children's Hospital, The Seventh Medical Center, PLA General Hospital, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhenqiu Liu
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Change Liu
- Pediatric Intensive Care Unit, Affiliated Bayi Children's Hospital, The Seventh Medical Center, PLA General Hospital, Beijing, China
| | - Jie Wang
- Surgical Pediatric Intensive Care Unit, Children's Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Xueli Quan
- Surgical Pediatric Intensive Care Unit, Children's Hospital Affiliated of Zhengzhou University, Zhengzhou, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Qiong Ji
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Jianwei Sun
- Department of Neonatology, Henang Provincial People's Hospital, Zhengzhou, China
| | - Donglinag Cheng
- Department of Neonatology, Henang Provincial People's Hospital, Zhengzhou, China
| | - Zhichun Feng
- Pediatric Intensive Care Unit, Affiliated Bayi Children's Hospital, The Seventh Medical Center, PLA General Hospital, Beijing, China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
| |
Collapse
|
12
|
Abstract
Sepsis and septic shock in newborns causes mortality and morbidity depending on the organism and primary site. ECMO provides cardiorespiratory support to allow adequate organ perfusion during the time for antibiotics and source control surgery (if needed) to occur. ECMO mode and cannulation site vary depending on support required and local preference. Earlier and more aggressive use of ECMO can improve survival.
Collapse
Affiliation(s)
- Warwick Wolf Butt
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Roberto Chiletti
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| |
Collapse
|
13
|
Kipfmueller F, Heindel K, Geipel A, Berg C, Bartmann P, Reutter H, Mueller A, Holdenrieder S. Expression of soluble receptor for advanced glycation end products is associated with disease severity in congenital diaphragmatic hernia. Am J Physiol Lung Cell Mol Physiol 2019; 316:L1061-L1069. [PMID: 30838867 DOI: 10.1152/ajplung.00359.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Pulmonary hypertension (PH) and lung hypoplasia are major contributors to morbidity and mortality in newborns with congenital diaphragmatic hernia (CDH). The soluble receptor for advanced glycation end products (sRAGE) is a marker of endothelial function and might be associated with disease severity in CDH newborns. In a cohort of 30 CDH newborns and 20 healthy control newborns, sRAGE concentration was measured at birth and at 6 h, 12 h, 24 h, 48 h, and 7-10 days. In healthy newborns, sRAGE was significantly higher at birth and at 48 h compared with CDH newborns (both P < 0.001). Among CDH newborns, sRAGE was significantly lower at birth (P = 0.033) and at 7-10 days (P = 0.035) in patients receiving extracorporeal membrane oxygenation (ECMO) compared with patients not receiving ECMO. In contrast, CDH newborns receiving ECMO had significantly higher values at 6 h (P = 0.001), 12 h (P = 0.004), and 48 h (0.032). Additionally, sRAGE correlated significantly with PH severity, intensity and duration of mechanical ventilation, and prenatally assessed markers of CDH severity (lung size, liver herniation). The probability to receive ECMO therapy was five times higher in CDH newborns with sRAGE concentrations below the calculated cutoff of 650 pg/ml at birth (P = 0.002) and nine times higher in CDH newborns with sRAGE concentrations above the cutoff of 3,500 pg/ml at 6 h (P = 0.001). These findings suggest a potential involvement of sRAGE in the pathophysiology of CDH and may act as a therapeutic target in future treatment approaches.
Collapse
Affiliation(s)
- Florian Kipfmueller
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn , Bonn , Germany
| | - Katrin Heindel
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn , Bonn , Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn , Bonn , Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn , Bonn , Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn , Bonn , Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn , Bonn , Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn , Bonn , Germany
| | - Stefan Holdenrieder
- Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn , Bonn , Germany.,Institute for Laboratory Medicine, German Heart Center of the State of Bavaria and the Technical University Munich , Munich , Germany
| |
Collapse
|
14
|
Dolscheid-Pommerich RC, Kreuzer A, Graeff I, Stoffel-Wagner B, Mueller A, Kipfmueller F. Haematopoietic alterations in neonates with congenital diaphragmatic hernia receiving extracorporeal membrane oxygenation support. Ann Clin Biochem 2019; 56:247-252. [PMID: 30514095 DOI: 10.1177/0004563218820052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation procedure (ECMO) has been established in the therapy of respiratory insufficient infants with congenital diaphragmatic hernia. In congenital diaphragmatic hernia newborns, a delay in transfer to an ECMO centre is associated with a sharp increase in mortality. Predictive factors for ECMO support are urgently needed. We evaluated the routine parameters of the first blood withdrawal after birth in congenital diaphragmatic hernia infants, hypothesizing that early signs in bone marrow affecting haematology parameters for early regulation of potentially post birth hypoxia are predictive factors for ECMO support. MATERIALS AND METHODS In 44 patients born with congenital diaphragmatic hernia, differential blood cell count from the first blood withdrawal after birth was examined. Descriptive statistics included median, 95% confidence intervals, minimum and maximum differentiating ECMO/early mortality vs. no ECMO. Odds ratios with CI were calculated by binary logistic regression analysis. Best predictive markers were further checked in combination with the liver-up situation in two factorial regression models. RESULTS In our cohort, the survival rate was 77.3% (34/44). While 18 neonates received ECMO support, 26 experienced no ECMO during hospital stay. Odds ratio calculations showed that risk for ECMO support increases with augmenting leukocytes, erythrocytes, haemoglobin, haematocrit, mean cell volume and absolute immature granulocytes. Further, the risk advanced in line with the severity of congenital diaphragmatic hernia assessed by prenatal ultrasound. CONCLUSIONS We conclude that these parameters are associated with disease severity in congenital diaphragmatic hernia newborns and may be considered potentially predictive biomarkers for the necessity of ECMO support.
Collapse
Affiliation(s)
| | - Alexander Kreuzer
- 2 Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Bonn, Germany
| | - Ingo Graeff
- 3 Emergency Department, University Hospital Bonn, Bonn, Germany
| | - Birgit Stoffel-Wagner
- 1 Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Andreas Mueller
- 2 Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Bonn, Germany
| | - Florian Kipfmueller
- 2 Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Bonn, Germany
| |
Collapse
|
15
|
Rafat N, Schaible T. Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia. Front Pediatr 2019; 7:336. [PMID: 31440491 PMCID: PMC6694279 DOI: 10.3389/fped.2019.00336] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/24/2019] [Indexed: 01/04/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) is characterized by failure of diaphragmatic development with lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). If conventional treatment with gentle ventilation and optimized vasoactive medication fails, extracorporeal membrane oxygenation (ECMO) may be considered. The benefits of ECMO in CDH are still controversial, since there are only few randomized trials demonstrating the advantages of this therapeutic option. At present, there is no precise prenatal and/or early postnatal prognostication parameter to predict reversibility of PPHN in CDH patients. Indications for initiating ECMO include either respiratory or circulatory parameters, which are also undergoing continuous refinement. Centers with higher case numbers and the availability of ECMO published promising survival rates, but data on long-term results, including morbidity and quality of life, are rare. Survival might be influenced by the timing of ECMO initiation and the timing of surgical repair. In this regard a trend toward early initiation of ECMO and early surgery on ECMO exists. The results concerning the cannulation modes are similar and a consensus on time limit for ECMO runs does not exist. The use of ECMO in CDH will continue to be evaluated, and prospective randomized trials and registry network are necessary to help answering the addressed questions of patient selection and management.
Collapse
Affiliation(s)
- Neysan Rafat
- Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Schaible
- Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
16
|
Rafat N, Patry C, Sabet U, Viergutz T, Weiss C, Tönshoff B, Beck G, Schaible T. Endothelial Progenitor and Mesenchymal Stromal Cells in Newborns With Congenital Diaphragmatic Hernia Undergoing Extracorporeal Membrane Oxygenation. Front Pediatr 2019; 7:490. [PMID: 31824902 PMCID: PMC6882772 DOI: 10.3389/fped.2019.00490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/07/2019] [Indexed: 02/03/2023] Open
Abstract
Background: Endothelial progenitor (EPC) and mesenchymal stromal cells (MSC) can regenerate damaged endothelium and thereby improve pulmonary endothelial dysfunction. We do not know, how extracorporeal membrane oxygenation (ECMO) might affect EPC- and MSC-mediated regenerative pathways in patients with congenital diaphragmatic hernia (CDH). Therefore, we investigated, if ECMO support impacts EPC and MSC numbers in CDH patients. Methods: Peripheral blood mononuclear cells from newborns with ECMO-dependent (n = 18) and ECMO-independent CDH (n = 12) and from healthy controls (n = 12) were isolated. The numbers of EPC and MSC were identified by flowcytometry. Serum levels of vascular endothelial growth factor (VEGF) and angiopoietin (Ang)-2 were determined. Results: EPC and MSC were elevated in newborns with CDH. ECMO-dependent infants had higher EPC subpopulation counts (2,1-7,6-fold) before treatment compared to ECMO-independent infants. In the disease course, EPC and MSC subpopulation counts in ECMO-dependent infants were lower than before ECMO initiation. During ECMO, VEGF serum levels were significantly reduced (by 90.5%) and Ang2 levels significantly increased (by 74.8%). Conclusions: Our data suggest that ECMO might be associated with a rather impaired mobilization of EPC and MSC and with a depression of VEGF serum levels in newborns with CDH.
Collapse
Affiliation(s)
- Neysan Rafat
- Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany.,Department of Pharmaceutical Sciences, Bahá'í Institute of Higher Education (BIHE), Teheran, Iran
| | - Christian Patry
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Sabet
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Tim Viergutz
- Department of Anesthesiology and Critical Care Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiss
- Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Grietje Beck
- Department of Anesthesiology, Helios Dr. Horst-Schmidt Clinic, Wiesbaden, Germany
| | - Thomas Schaible
- Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
17
|
Nakwan N, Jain S, Kumar K, Hosono S, Hammoud M, Elsayed YY, Ariff S, Hasan B, Khowaja W, Poon WB. An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: incidence, etiology, diagnosis, treatment and outcome. J Matern Fetal Neonatal Med 2018; 33:2032-2037. [PMID: 30318951 DOI: 10.1080/14767058.2018.1536740] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: To explore the incidence, etiologies, diagnostic methods, treatment options and outcomes in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to identify mortality risk factors in a study from six Asian countries.Methods: A retrospective chart review of patients with documented PPHN from seven centers in six Asian countries (Japan, Kuwait, India, Pakistan, Singapore, and Thailand) between 1 January, 2014 and 31 December, 2016, was performed.Results: A total of 369 PPHN infants were identified. The incidence of PPHN ranged from 1.2 to 4.6 per 1000 live births. The all-cause mortality rate was 20.6% (76 of 369). Meconium aspiration syndrome was the primary cause of PPHN (24.1%). In most cases (84.8%) echocardiography was used to establish the diagnosis of PPHN. Sildenafil was the most commonly used pulmonary vasodilator (51.2%). Multivariate multiple regression analysis indicated gestational age <34 weeks (adjusted odds ratio (OR) = 3.27; 95% CI 1.56-6.74), congenital diaphragmatic hernia (CDH)/lung hypoplasia (LH) (adjusted OR = 6.13 (95% CI 2.28-16.42)), treatment with high frequency oscillation ventilation (HFOV) with or without inhaled nitric oxide (iNO) (adjusted OR = 3.11 (95% CI 1.52-6.34)), and inotropic agents (adjusted OR = 9.43 (95% CI 2.71-32.83)) were independently associated with increased risk of death.Conclusions: The incidence of PPHN in the current study was higher than in western settings. Birth weight, gestational age, CDH/LH, HFOV/iNO, and inotropic agents were significant mortality risk factors.
Collapse
Affiliation(s)
- Narongsak Nakwan
- Department of Pediatrics, Hat Yai Medical Education Center, Hat Yai Hospital, Songkhla, Thailand
| | - Suksham Jain
- Department of Pediatrics, Govt. Medical College and Hospital, Chandigarh, India
| | - Kishore Kumar
- Department of Pediatrics, Cloudnine Hospital, Bangalore, India
| | - Shigeharu Hosono
- Division of Neonatology, Department of Perinatal and Neonatal Medicine, Jichi Medical University, Saitama, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Majeda Hammoud
- Department of Pediatrics and Neonatology, Faculty of Medicine, Kuwait University and Al-Sabah Maternity Hospital, Kuwait
| | - Yasser Yahia Elsayed
- Department of Pediatrics and Neonatology, Faculty of Medicine, Kuwait University and Al-Sabah Maternity Hospital, Kuwait
| | - Shabina Ariff
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Babar Hasan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Waqar Khowaja
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| |
Collapse
|
18
|
Kipfmueller F, Heindel K, Schroeder L, Berg C, Dewald O, Reutter H, Bartmann P, Mueller A. Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia. J Perinat Med 2018; 46:735-743. [PMID: 28742524 DOI: 10.1515/jpm-2017-0031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/30/2017] [Indexed: 11/15/2022]
Abstract
AbstractObjective:Echocardiography is the most important tool to assess infants with congenital diaphragmatic hernia (CDH) for pulmonary hypertension (PH). The pattern of blood flow in the pulmonary artery [described as time to peak velocity (TPV)/right ventricular ejection time (RVET) ratio] provides distinct information about pulmonary arterial pressure. The aim of our study was to investigate the correlation of TPV/RVET measurements with the most commonly used classification system for PH in CDH newborns and the association of these measurements with outcome parameters.Methods:Echocardiographic measurements were obtained in 40 CDH newborns within 6 h of life. The obtained measurements were correlated with the decision for or against extracorporeal membrane oxygenation (ECMO); early mortality; total duration of mechanical ventilation and total duration of oxygen supplementation.Results:The correlation coefficient between severity of PH and TPV/RVET measurements was −0.696 (P<0.001). Using receiver operating characteristic (ROC) analyses the optimal cutoff for TPV/RVET in order to predict the necessity for ECMO or early mortality without ECMO was 0.29 with a sensitivity of 86.7%, a specificity of 68%, a positive predictive value of 61.9% and a negative predictive value of 89.5%. Newborns with a TPV/RVET below the cutoff had a 5.9-fold risk for ECMO or early mortality, a significantly longer duration of mechanical ventilation (13.4 days vs. 7.4 days, P=0.003) and oxygen supplementation (22.4 days vs. 9.0 days, P=0.019), and a lower survival rate (76.2% vs. 100%, P=0.021).Conclusions:TPV/RVET is a feasible parameter to assess PH in CDH newborns with close correlation to outcome parameters.
Collapse
Affiliation(s)
- Florian Kipfmueller
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Katrin Heindel
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Lukas Schroeder
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.,Institute of Human Genetics, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Andreas Mueller
- Department of Neonatology and Pediatric Critical Care Medicine, University of Bonn Children's Hospital, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| |
Collapse
|
19
|
Factors Associated With Mortality in Children Who Successfully Wean From Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med 2018; 19:875-883. [PMID: 29965888 DOI: 10.1097/pcc.0000000000001642] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation is an established therapy for cardiac and respiratory failure unresponsive to usual care. Extracorporeal membrane oxygenation mortality remains high, with ongoing risk of death even after successful decannulation. We describe occurrence and factors associated with mortality in children weaned from extracorporeal membrane oxygenation. DESIGN Retrospective cohort study. SETTING Two hundred five extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization. SUBJECTS Eleven thousand ninety-six patients, less than 18 years, supported with extracorporeal membrane oxygenation during 2007-2013, who achieved organ recovery before decannulation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome was hospital mortality less than or equal to 30 days post extracorporeal membrane oxygenation decannulation. Among 11,096 patients, indication for extracorporeal membrane oxygenation cannulation was respiratory (6,206; 56%), cardiac (3,663; 33%), or cardiac arrest (extracorporeal cardiopulmonary resuscitation, 1,227; 11%); the majority were supported with venoarterial extracorporeal membrane oxygenation at some stage in their course (8,576 patients; 77%). Mortality was 13%. Factors associated with mortality included younger age (all < 1 yr categories compared with older, p < 0.05), lower weight among neonates (≤ 3 vs > 3 kg; p < 0.001), mode of extracorporeal membrane oxygenation support (venoarterial extracorporeal membrane oxygenation compared with venovenous extracorporeal membrane oxygenation, p < 0.001), longer admission to extracorporeal membrane oxygenation cannulation time (≥ 28 vs < 28 hr; p < 0.001), cardiac and extracorporeal cardiopulmonary resuscitation compared with respiratory extracorporeal membrane oxygenation (both p < 0.001), extracorporeal membrane oxygenation duration greater than or equal to 135 hours (p < 0.001), preextracorporeal membrane oxygenation hypoxemia (PO2 ≤ 43 vs > 43 mm Hg; p < 0.001), preextracorporeal membrane oxygenation acidemia (p < 0.001), and extracorporeal membrane oxygenation complications, particularly cerebral or renal (both p < 0.001). CONCLUSIONS Despite extracorporeal membrane oxygenation decannulation for organ recovery, 13% of patients die in hospital. Mortality is associated with patient factors, preextracorporeal membrane oxygenation illness severity, and extracorporeal membrane oxygenation management. Evidence-based strategies to optimize readiness for extracorporeal membrane oxygenation decannulation and postextracorporeal membrane oxygenation decannulation care are needed.
Collapse
|
20
|
Yang XF, Li BF, Miao JH, Zheng KJ, Cheng Z, Liao XZ, Wang LQ, Chen J. [Application of extracorporeal membrane oxygenation in 4 critically in neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:1114-1117. [PMID: 29046211 PMCID: PMC7389276 DOI: 10.7499/j.issn.1008-8830.2017.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Xiu-Fang Yang
- Department of NICU, Zhongshan People's Hospital of Guangdong Province, Zhongshan, Guangdong 528403, China
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Kuok CM, Tsao PN, Chen CY, Chou HC, Hsieh WS, Huang SC, Chen YS, Wu ET. Extracorporeal Membrane Oxygenation Support in Neonates: A Single Medical Center Experience in Taiwan. Pediatr Neonatol 2017; 58:355-361. [PMID: 28223011 DOI: 10.1016/j.pedneo.2016.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/26/2016] [Accepted: 08/02/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) was used in neonates with severe cardiopulmonary failure who failed to respond to conventional therapy. We started to apply neck venoarterial ECMO (VA-ECMO) in neonatal patients from 2000. In this study, we have focused on neonates who received ECMO support and described the current status of ECMO in neonates for both cardiac and pulmonary support and the risk factors associated with their outcomes. METHODS Data were retrieved from our ECMO database for the neonates (age < 28 days) who received neck VA-ECMO support from January 2005 to June 2015. RESULTS In total, 27 neonates, including 21 with respiratory support and six with cardiac support, were enrolled in this study. Sixteen (59.2%) patients survived to hospital discharge, and only one patient had a poor neurological outcome. The survival rate for respiratory support was 61.9% in which meconium aspiration syndrome with persistent pulmonary hypertension of a newborn had a superior outcome (11/13, 84.6%) and congenital diaphragmatic hernia had the worst outcome (4/7, 57.1%). The survival rate in the cardiac support group was only 50%. The median ECMO duration and hospital stay were 6 (1∼35.8) days and 37 (23∼232) days, respectively, for survivors. Furthermore, 11 (52.3%) neonates of 21 outborn patients were put on ECMO in other hospitals by our mobile ECMO team for respiratory support, and their survival (81.8%) was significantly better than those from in-house ECMO institution (40%). CONCLUSION This is the first report for ECMO in neonatal disease in Taiwan. We achieved an overall survival rate of 59.2% with good neurological outcomes in this 10-year experience. ECMO could be a useful transportation tool for critical neonates who have a poor response to ventilator support.
Collapse
Affiliation(s)
- Chi-Man Kuok
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Cardiothoracic Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiothoracic Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Children Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
22
|
Baerg JE, Thirumoorthi A, Hopper AO, Tagge EP. The use of ECMO for gastroschisis and omphalocele: Two decades of experience. J Pediatr Surg 2017; 52:984-988. [PMID: 28410786 DOI: 10.1016/j.jpedsurg.2017.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim was to review the respiratory failure causes and outcomes of infants with omphalocele or gastroschisis receiving ECMO and reported to the Extracorporeal Life Support Organization (ELSO). METHODS Gastroschisis and omphalocele infants supported with ECMO and reported to the ELSO Registry between 1992 and 2015 were retrospectively reviewed. Clinical variables, diagnosis of respiratory failure (pulmonary hypertension (PHN), congenital heart defects (CHD), congenital diaphragmatic hernia (CDH), and sepsis), and outcomes were recorded. Univariate analysis was performed using Student's t-test for continuous or Fisher's exact test for categorical variables. RESULTS Fifty-two infants with gastroschisis (41) (79%) or omphalocele (11) (21%) were identified. The survival to discharge rate of 51% for gastroschisis remained stable and was significantly higher (P=0.05). The overall mortality rate for omphalocele was 82%. Omphalocele had significantly more PHN (P<0.01), CDH (P<0.01), and multiple anomalies (P=0.04) had significantly more sepsis (P=0.02), and none had a CDH. CONCLUSION Infants with gastroschisis requiring ECMO support have significantly better survival than omphaloceles, and respiratory failure is significantly associated with sepsis. The majority of omphalocele infants die despite ECMO, and respiratory failure is associated PHN and CDH. The association of omphalocele, PHN, and CDH merits further investigation. STUDY TYPE AND EVIDENCE LEVEL Retrospective comparative study of Registry Database, Level 3.
Collapse
Affiliation(s)
- Joanne E Baerg
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA.
| | - Arul Thirumoorthi
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Andrew O Hopper
- Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Edward P Tagge
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| |
Collapse
|
23
|
Abstract
Extracorporeal membrane oxygenation (ECMO) is a pivotal bridge to recovery for cardiopulmonary failure in children. Besides its life-saving quality, it is often associated with severe system-related complications, such as hemolysis, inflammation, and thromboembolism. Novel oxygenator and pump systems may reduce such ECMO-related complications. The ExMeTrA oxygenator is a newly designed pediatric oxygenator with an integrated pulsatile pump minimizing the priming volume and reducing the surface area of blood contact. The aim of our study was to investigate the feasibility and safety of this new ExMeTrA (expansion mediated transport and accumulation) oxygenator in an animal model. During 6 h of extracorporeal circulation (ECC) in pigs, parameters of the hemostatic system including coagulation, platelets and complement activation, and flow rates were investigated. A nonsignificant trend in C3 consumption, thrombin-antithrombin-III (TAT) complex formation and a slight trend in hemolysis were detected. During the ECC, the blood flow was constantly at 500 ml/min using only flexible silicone tubes inside the oxygenator as pulsatile pump. Our data clearly indicate that the hemostatic markers were only slightly influenced by the ExMeTrA oxygenator. Additionally, the oxygenator showed a constant quality of blood flow. Therefore, this novel pediatric oxygenator shows the potential to be used in pediatric and neonatal support with ECMO.
Collapse
|
24
|
Barbaro RP, Bartlett RH, Chapman RL, Paden ML, Roberts LA, Gebremariam A, Annich GM, Davis MM. Development and Validation of the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support. J Pediatr 2016; 173:56-61.e3. [PMID: 27004674 PMCID: PMC4884525 DOI: 10.1016/j.jpeds.2016.02.057] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/14/2016] [Accepted: 02/19/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop and validate the Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support, which estimates the risk of in-hospital death for neonates prior to receiving respiratory extracorporeal membrane oxygenation (ECMO) support. STUDY DESIGN We used an international ECMO registry (2008-2013); neonates receiving ECMO for respiratory support were included. We divided the registry into a derivation sample and internal validation sample, by calendar date. We chose candidate variables a priori based on published evidence of association with mortality; variables independently associated with mortality in logistic regression were included in this parsimonious model of risk adjustment. We evaluated model discrimination with the area under the receiver operating characteristic curve (AUC), and we evaluated calibration with the Hosmer-Lemeshow goodness-of-fit test. RESULTS During 2008-2013, 4592 neonates received ECMO respiratory support with mortality of 31%. The development dataset contained 3139 patients treated in 2008-2011. The Neo-RESCUERS measure had an AUC of 0.78 (95% CI 0.76-0.79). The validation cohort had an AUC = 0.77 (0.75-0.80). Patients in the lowest risk decile had an observed mortality of 7.0% and a predicted mortality of 4.4%, and those in the highest risk decile had an observed mortality of 65.6% and a predicted mortality of 67.5%. CONCLUSIONS Neonatal Risk Estimate Score for Children Using Extracorporeal Respiratory Support offers severity-of-illness adjustment for neonatal patients with respiratory failure receiving ECMO. This score may be used to adjust patient survival to assess hospital-level performance in ECMO-based care.
Collapse
Affiliation(s)
- Ryan P Barbaro
- Department of Pediatrics, University of Michigan, Ann Arbor, MI; Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI.
| | | | - Rachel L Chapman
- Department of Pediatrics, University of Southern California, Los Angeles and Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Matthew L Paden
- Division of Pediatric Critical Care, Emory University, Atlanta, GA
| | - Lloyd A Roberts
- Intensive Care Department, Alfred Hospital, Monash University, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Achamyeleh Gebremariam
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI
| | - Gail M Annich
- Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Matthew M Davis
- Department of Pediatrics, University of Michigan, Ann Arbor, MI; Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Gerald R. Ford School of Public Policy and School of Public Health, University of Michigan, Ann Arbor, MI
| |
Collapse
|
25
|
Hofer N, Jank K, Strenger V, Pansy J, Resch B. Inflammatory indices in meconium aspiration syndrome. Pediatr Pulmonol 2016; 51:601-6. [PMID: 26663621 DOI: 10.1002/ppul.23349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 10/20/2015] [Accepted: 11/02/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Meconium aspiration syndrome (MAS) is linked to inflammation, but data on the patterns of hematological indices and C-reactive protein (CRP) in MAS are lacking. The aim of the study was to evaluate CRP, white blood cell count (WBC), absolute neutrophil count (ANC), and immature-to-total neutrophil ratio (IT-ratio) in MAS and to assess their association with disease severity. METHODS Retrospective cross-sectional study including 239 consecutively admitted neonates with MAS to a level III NICU. Neonates with early onset sepsis were excluded. Results Neonates with severe MAS (invasive mechanical ventilation for <7 days) and very severe MAS (invasive mechanical ventilation for ≥7 days or high frequency ventilation or ECMO) had higher CRP and IT-ratio compared to neonates with non-severe MAS (no invasive mechanical ventilation) during the first 2 days of life (CRP: 13.0 and 40.9 vs. 9.5 mg/L, P = 0.039 and <0.001, respectively) and neonates with very severe MAS had lower WBC and ANC. All four inflammatory indices correlated significantly with duration of invasive mechanical ventilation, duration of respiratory support and with length of hospital stay, arterial hypotension, and persistent pulmonary hypertension. Neonates with all four inflammatory indices beyond the normal range had a more than 20-fold increase in risk for very severe MAS. CONCLUSION High CRP and IT-ratio and low WBC and ANC values were closely linked to a more severe course of MAS during the early phases of the disease. These findings reflect the role of inflammation in the pathogenesis of MAS. Pediatr Pulmonol. 2016;51:601-606. 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Nora Hofer
- Pediatric Intensive Care Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Katharina Jank
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Volker Strenger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
26
|
[Extracorporeal membrane oxygenation in children]. Med Klin Intensivmed Notfmed 2015; 110:438-44. [PMID: 26267893 DOI: 10.1007/s00063-015-0062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Children who require mechanical ventilation represent a high-risk population with significant morbidity and mortality. Experienced handling of conventional therapies including high frequency oscillation ventilation and initiation of newer treatment options such as surfactant or nitric oxide has led to some improvements. Nevertheless, extracorporeal membrane oxygenation (ECMO) is a life-saving technology in patients with respiratory failure refractory to maximal medical therapy. OBJECTIVE This article shows the therapeutic management and the selection criteria for ECMO in neonates and children based on the clinical signs of acquired and congenital diseases that can lead to respiratory failure. RESULTS The distribution of diagnoses, survival rates, and demographic change of ECMO in newborns since the beginning of documentation in 1986 by the Extracorporeal Life Support Organization (ELSO) registry and the largest German ECMO Center Mannheim are described. Despite a changed diagnostic distribution in the direction of congenital pulmonary disease, the survival rate of ECMO in the neonates has remained well above 70 %. In pediatric ECMO, the survival rate has also remained constant despite a more complex patient population. The highest values are seen in the youngest patients without underlying disease. CONCLUSION Despite limited evidence and relatively few randomized trials in children, ECMO remains the safety net for patients with severe respiratory failure. Experience as measured by the annual number of cases plays an important role for the quality of results.
Collapse
|
27
|
Nakwan N, Pithaklimnuwong S. Acute kidney injury and pneumothorax are risk factors for mortality in persistent pulmonary hypertension of the newborn in Thai neonates. J Matern Fetal Neonatal Med 2015. [DOI: 10.3109/14767058.2015.1060213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
28
|
Wang L, Xu XP, Zhan H, Zhang SM. Application of ECMO to the treatment of benign double tracheoesophageal fistula: report of a case. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:423-6. [PMID: 24747543 DOI: 10.5761/atcs.cr.13-00313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This report presents the extracorporeal membrane oxygenation (ECMO)-assisted surgical as a treatment of benign double tracheoesophageal fistula. The patient was a 43-year-old woman who presented the airway obstruction for 3 weeks after the esophagus metal stent implantation for the tracheoesophageal fistula 1 year ago. The airway obstruction was due to the expansion and piercing of the metal stent through the upper part of the esophagus into the tracheal cavity. In view of the failure of endotracheal intubation, we finally used ECMO-assisted surgery to remove the stent. And at the same time, cervical esophagostomy externa, exclusion of the thoracic tracheoesophageal fistulas and gastrostomy were performed.
Collapse
Affiliation(s)
- Lei Wang
- Department of Cardiothoracic Surgery, The 455th Hospital of PLA, Shanghai, China
| | | | | | | |
Collapse
|
29
|
Gas Exchange Efficiency of an Oxygenator with Integrated Pulsatile Displacement Blood Pump for Neonatal Patients. Int J Artif Organs 2014; 37:88-92. [DOI: 10.5301/ijao.5000293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/20/2022]
Abstract
Oxygenators have been used in neonatal extracorporeal membrane oxygenation (ECMO) since the 1970s. The need to develop a more effective oxygenator for this patient cohort exists due to their size and blood volume limitations. This study sought to validate the next design iteration of a novel oxygenator for neonatal ECMO with an integrated pulsatile displacement pump, thereby superseding an additional blood pump. Pulsating blood flow within the oxygenator is generated by synchronized active air flow expansion and contraction of integrated silicone pump tubes and hose pinching valves located at the oxygenator inlet and outlet. The current redesign improved upon previous prototypes by optimizing silicone pump tube distribution within the oxygenator fiber bundle; introduction of an oval shaped inner fiber bundle core, and housing; and a higher fiber packing density, all of which in combination reduced the priming volume by about 50% (50 to 27 mL and 41 to 20 mL, respectively). Gas exchange efficiency was tested for two new oxygenators manufactured with different fiber materials: one with coating and one with smaller pore size, both capable of long-term use (OXYPLUS® and CELGARD®). Results demonstrated that the oxygen transfer for both oxygenators was 5.3-24.7 mlo2/min for blood flow ranges of 100-500 mlblood /min. Carbon dioxide transfer for both oxygenators was 3.7-26.3 mlCo2/min for the same blood flow range. These preliminary results validated the oxygenator redesign by demonstrating an increase in packing density and thus in gas transfer, an increase in pumping capacity and a reduction in priming volume.
Collapse
|
30
|
Rehder KJ, Turner DA, Bonadonna D, Walczak RJ, Rudder RJ, Cheifetz IM. Technological advances in extracorporeal membrane oxygenation for respiratory failure. Expert Rev Respir Med 2014; 6:377-84. [DOI: 10.1586/ers.12.31] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
31
|
Extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure: an evidence-based review of the past decade (2002-2012). Pediatr Crit Care Med 2013; 14:851-61. [PMID: 24108118 DOI: 10.1097/pcc.0b013e3182a5540d] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide a comprehensive evidence-based review of extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure. DATA SOURCE A thorough computerized bibliographic search of the clinical literature regarding the use of extracorporeal membrane oxygenation in the neonatal and pediatric populations. STUDY SELECTION Clinical trials published between January 1, 2002, and October 1, 2012, including "extracorporeal membrane oxygenation" or "ECMO" and limited to studies involving humans aged 0-18 years. Trials focused on extracorporeal membrane oxygenation for cardiac indications were excluded from this study, unless the study was evaluating ancillary therapies in conjunction with extracorporeal membrane oxygenation. DATA EXTRACTION Studies were evaluated for inclusion based on reporting of patient outcomes and/or strategic considerations, such as cannulation strategies, timing of extracorporeal membrane oxygenation utilization, and ancillary therapies. DATA SYNTHESIS Pertinent data are summarized, and the available data are objectively classified based on the value of the study design from which the data are obtained. CONCLUSIONS Despite a large number of published extracorporeal membrane oxygenation studies, there remains a paucity of high-quality clinical trials. The available data support continued use of extracorporeal membrane oxygenation for respiratory failure refractory to conventional therapy for neonatal and pediatric patients without significant comorbidities. Further research is needed to better quantify the benefit of extracorporeal membrane oxygenation and the utility of many therapies commonly applied to extracorporeal membrane oxygenation patients.
Collapse
|
32
|
Survival of newborn infants with severe respiratory failure before and after establishing an extracorporeal membrane oxygenation program. Pediatr Crit Care Med 2013; 14:876-83. [PMID: 23863822 DOI: 10.1097/pcc.0b013e318297622f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe hypoxic respiratory failure is a leading cause of neonatal mortality in Chile. Extracorporeal membrane oxygenation improves survival in neonates with hypoxic respiratory failure. OBJECTIVE To determine the impact of the establishment of a Neonatal Extracorporeal Membrane Oxygenation Program on the outcome of newborns with severe hypoxic respiratory failure in a developing country. DESIGN/PATIENTS Data of newborns (birthweight > 2,000 g and gestational age ≥ 35 wk) with hypoxic respiratory failure and oxygenation index greater than 25 were compared before and after extracorporeal membrane oxygenation was available. Extracorporeal membrane oxygenation was initiated in infants with refractory hypoxic respiratory failure who failed to respond to inhaled nitric oxide/high-frequency oscillatory ventilation. MAIN RESULTS Data from 259 infants were analyzed; 100 born in the pre-extracorporeal membrane oxygenation period and 159 born after the extracorporeal membrane oxygenation program was established. Patients were similar in terms of risk factors for death for both periods except for a higher oxygenation index and a greater proportion of outborn infants during the extracorporeal membrane oxygenation period. Survival significantly increased from 72% before extracorporeal membrane oxygenation to 89% during the extracorporeal membrane oxygenation period (p < 0.01). During the extracorporeal membrane oxygenation period, 98 of 159 patients (62%) with hypoxic respiratory failure were rescued using inhaled nitric oxide/high-frequency oscillatory ventilation, whereas 61 (38%) did not improve; 52 of these 61 neonates were placed on extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survival rate to discharge was 85%. After adjusting for potential confounders, the severity of the pretreatment oxygenation index, a late arrival to the referral center, the presence of a pneumothorax, and the diagnosis of a diaphragmatic hernia were significantly associated with the need for extracorporeal membrane oxygenation or death. CONCLUSIONS The establishment of an extracorporeal membrane oxygenation program was associated with a significant increase in the survival of newborns more than or equal to 35 weeks old with severe hypoxic respiratory failure.
Collapse
|
33
|
Pacifici GM. Clinical pharmacology of furosemide in neonates: a review. Pharmaceuticals (Basel) 2013; 6:1094-129. [PMID: 24276421 PMCID: PMC3818833 DOI: 10.3390/ph6091094] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 11/16/2022] Open
Abstract
Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2) is 6 to 20-fold longer, clearance (Cl) is 1.2 to 14-fold smaller and volume of distribution (Vd) is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.
Collapse
Affiliation(s)
- Gian Maria Pacifici
- Section of Pharmacology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56100, Italy.
| |
Collapse
|
34
|
Madderom MJ, Reuser JJCM, Utens EMWJ, van Rosmalen J, Raets M, Govaert P, Steiner K, Gischler SJ, Tibboel D, van Heijst AFJ, Ijsselstijn H. Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study. Intensive Care Med 2013; 39:1584-93. [PMID: 23740280 DOI: 10.1007/s00134-013-2973-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/20/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE Reporting neurodevelopmental outcome of 8-year-old children treated with neonatal extracorporeal membrane oxygenation (ECMO). METHODS In a follow-up study in 135 8-year-old children who received neonatal ECMO between 1996 and 2001 we assessed intelligence (Revised Amsterdam Intelligence Test), concentration (Bourdon-Vos test), eye-hand coordination (Developmental Test of Visual-Motor Integration) and behavior (Child Behavior Checklist and Teacher Report Form). RESULTS Intelligence fell within normal range (mean IQ 99.9, SD 17.7, n = 125) with 91 % of the children following regular education. Significantly more children attended special education (9 %) or received extra support in regular education (39 %) compared with normative data. Slower working speed (χ(2) = 132.36, p < 0.001) and less accuracy (χ(2) = 12.90, p < 0.001) were found on the Bourdon-Vos test (n = 123) compared with normative data. Eye-hand coordination fell within the normal range (mean 97.6, SD 14.3, n = 126); children with congenital diaphragmatic hernia scored lowest but still normally (mean 91.0, SD 16.4, n = 28). Mothers (n = 117) indicated more somatic and attention behavior problems; teachers (n = 115) indicated more somatic, social, thought, aggression and total problems compared with normative data. Mothers indicated more somatic problems than teachers (p = 0.003); teachers reported more attention problems than mothers (p = 0.036; n = 111). CONCLUSIONS Eight-year-old children treated with neonatal ECMO fall in the normal range of intelligence with problems with concentration and behavior. Long-term follow-up for children treated with neonatal ECMO should focus on early detection of (subtle) learning deficits.
Collapse
Affiliation(s)
- Marlous J Madderom
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Room Sk 1280; dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Artificial Placenta - Lung Assist Devices for Term and Preterm Newborns with Respiratory Failure. Int J Artif Organs 2013; 36:377-91. [DOI: 10.5301/ijao.5000195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 11/20/2022]
Abstract
Respiratory insufficiency is a major cause of neonatal mortality and long-term morbidity, especially in very low birth weight infants. Today, non-invasive and mechanical ventilation are commonly accepted procedures to provide respiratory support to newborns, but they can reach their limit of efficacy. To overcome this technological plateau and further reduce mortality rates, the technology of an “artificial placenta”, which is a pumpless lung assist device connected to the umbilical vessels, would serve to expand the therapeutic spectrum when mechanical ventilation becomes inadequate to treat neonates with severe respiratory insufficiency. The first attempts to create such an artificial placenta took place more than 60 years ago. However, there has been a recent renaissance of this concept, including developments of its major components like the oxygenator, vascular access via umbilical vessels, flow control, as well as methods to achieve hemocompatibility in extracorporeal circuits. This paper gives a review of past and current development, animal experiments and human case studies of artificial placenta technology.
Collapse
|
36
|
van Berkel S, Binkhorst M, van Heijst AFJ, Wijnen MHWA, Liem KD. Adapted ECMO criteria for newborns with persistent pulmonary hypertension after inhaled nitric oxide and/or high-frequency oscillatory ventilation. Intensive Care Med 2013; 39:1113-20. [PMID: 23580134 DOI: 10.1007/s00134-013-2907-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Early prediction of extracorporeal membrane oxygenation (ECMO) requirement in term newborns with persistent pulmonary hypertension (PPHN), partially responding to inhaled nitric oxide (iNO) and/or high-frequency oscillatory ventilation (HFOV), based on oxygenation parameters. METHODS This was a retrospective cohort study in 53 partial responders from among 133 term newborns with PPHN born between 2002 and 2007. Alveolar-to-arterial oxygen gradient (AaDO₂) values were determined in these 53 partial responders during the initial 72 h of iNO and/or HFOV treatment and compared between newborns who ultimately did (n = 11) and did not (n = 42) need ECMO. RESULTS Over 72 h, partial responders not requiring ECMO showed a more profound AaDO₂ decrease than those who needed ECMO (median decline 242.5 mmHg, IQR 144 to 353 mmHg, vs. 35 mmHg, IQR -15 to 123 mmHg; p = 0.0007). A decline of <123 mmHg over 72 h predicted the need for ECMO (sensitivity 82 %, specificity 79 %). At 72 h, AaDO₂ was significantly lower in partial responders without the need for ECMO than in those who did need ECMO (median 369 mmHg, IQR 258 to 478 mmHg, vs. 570 mmHg IQR 455 to 590 mmHg; p = 0.0008). An AaDO₂ >561 mmHg at 72 h predicted the need for ECMO (sensitivity 64 %, specificity 95 %, positive predictive value 78 %). CONCLUSIONS In term newborns with PPHN partially responding to iNO and/or HFOV, oxygenation-based prediction of the need for ECMO appears to be possible after 72 h. ECMO centers are encouraged to develop their own prediction model in order to prevent both lung damage and unnecessary ECMO runs.
Collapse
Affiliation(s)
- Saskia van Berkel
- Division of Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
| | | | | | | | | |
Collapse
|
37
|
Turek JW, Andersen ND, Lawson DS, Bonadonna D, Turley RS, Peters MA, Jaggers J, Lodge AJ. Outcomes before and after implementation of a pediatric rapid-response extracorporeal membrane oxygenation program. Ann Thorac Surg 2013; 95:2140-6; discussion 2146-7. [PMID: 23506632 DOI: 10.1016/j.athoracsur.2013.01.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/11/2013] [Accepted: 01/27/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rapid-response extracorporeal membrane oxygenation (RR-ECMO) has been implemented at select centers to expedite cannulation for patients placed on ECMO during extracorporeal cardiopulmonary resuscitation (ECPR). In 2008, we established such a program and used it for all pediatric venoarterial ECMO initiations. This study was designed to compare outcomes before and after program implementation. METHODS Between 2003 and 2011, 144 pediatric patients were placed on venoarterial ECMO. Records of patients placed on ECMO before (17 ECPR and 62 non-ECPR) or after (14 ECPR and 51 non-ECPR) RR-ECMO program implementation were retrospectively compared. RESULTS The peak performance of the ECMO team was assessed by measuring ECMO initiation times for the ECPR patient subgroup (n = 31). There was a shift toward more ECPR initiations achieved in less than 40 minutes (24% pre-RR-ECMO versus 43% RR-ECMO; p = 0.25) and fewer requiring more than 60 minutes (47% pre-RR-ECMO versus 21% RR-ECMO; p = 0.14) after program implementation, although these changes did not reach statistical significance. After multivariable risk adjustment, RR-ECMO was associated with a 52% reduction in neurologic complications for all patients (adjusted odds ratio, 0.48; 95% confidence interval, 0.23 to 0.98; p = 0.04), but the risk of in-hospital death remained unchanged (adjusted odds ratio, 0.99; 95% confidence interval, 0.50 to 1.99; p = 0.99). CONCLUSIONS Implementation of a pediatric RR-ECMO program for venoarterial ECMO initiation was associated with reduced neurologic complications but not improved survival during the first 3 years of program implementation. These data suggest that development of a coordinated system for rapid ECMO deployment may benefit both ECPR and non-ECPR patients, but further efforts are required to improve survival.
Collapse
Affiliation(s)
- Joseph W Turek
- Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | | | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Diemert A, Diehl W, Glosemeyer P, Deprest J, Hecher K. Intrauterine surgery--choices and limitations. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:603-38. [PMID: 23093990 DOI: 10.3238/arztebl.2012.0603] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 04/25/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND The past decade has seen much progress in intrauterine surgery. Randomized trials have documented the benefit of some procedures of this type for the unborn child. METHOD Selective literature review RESULTS Randomized trials have demonstrated the benefit of fetoscopic laser coagulation of placental anastomoses in twin-to-twin transfusion syndrome (TTTS) and of intrauterine surgery via hysterotomy for the repair of spina bifida. Other fetoscopic procedures have yielded promising initial results but are not yet supported by findings from randomized trials. Some intrauterine surgical procedures must still be considered experimental in view of the lack of randomized trials and the rarity of the conditions they are designed to treat. Fetoscopic laser coagulation for TTTS is by far the most common procedure in fetal surgery; TTTS arises in roughly 1 in 2500 pregnancies. The other procedures discussed in this article are performed much less often and for rarer indications. In general, intrauterine surgery is indicated only to treat conditions that would otherwise lead to intrauterine death or irreversible prenatal damage. CONCLUSION Intrauterine surgery is a rapidly developing field. Prenatal intervention by laser coagulation is indicated to treat severe TTTS, as its benefit has been shown in a randomized trial. Not enough evidence is yet available for the possible benefit of intrauterine surgery to treat myelomeningocele and congenital diaphragmatic hernia. Other indications are experimental. When an indication for intrauterine surgery exists, the parents should be informed and, depending on their wishes, referred to a center where it can be performed.
Collapse
Affiliation(s)
- Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | | | | | | | | |
Collapse
|
40
|
Extrakorporale Membranoxygenierung (ECMO). Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
41
|
Bertolini G, Rossi C, Crespi D, Finazzi S, Morandotti M, Rossi S, Peta M, Langer M, Poole D. Is influenza A(H1N1) pneumonia more severe than other community-acquired pneumonias? Results of the GiViTI survey of 155 Italian ICUs. Intensive Care Med 2011; 37:1746-55. [PMID: 21847646 PMCID: PMC7094960 DOI: 10.1007/s00134-011-2339-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 07/24/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Uncertainty about the severity of the A(H1N1) pandemia persists. Information about disease severity can be obtained by investigating intensive care unit (ICU) admissions, especially when historical comparisons can be made with cases of community-acquired pneumonia (CAP). METHODS This prospective observational study was conducted in 155 ICUs contributing to the GiViTI national database. To assess the impact on ICU workload, the occupancy rate during the epidemic phase was compared with influenza periods in previous years. A logistic regression model was developed to assess the prognostic importance of A(H1N1) influenza. RESULTS The characteristics of the 319 A(H1N1) cases were similar to those reported in other studies, confirming the young age of patients (mean 43 years) and the higher prevalence among pregnant women and obese people. At the epidemic's peak (October-December 2009) the occupancy rate did not significantly differ from the same period of the previous year, and was significantly lower than the 2009 seasonal influenza outbreak (January-March 2009). Compared with CAP of other origin (3,678 patients), A(H1N1) pneumonia was associated with a lower risk of death. However, after adjusting for confounding this was no longer the case (OR 0.88; 95% CI 0.59-1.31; p = 0.52). CONCLUSION This study confirmed the specific features of critically ill A(H1N1) patients (i.e., young age, pregnancy, obesity). The pandemic did not increase ICU workload compared with other periods. A(H1N1) pneumonia did not have a higher risk of death than CAP of different origin among patients admitted to the ICU.
Collapse
Affiliation(s)
- Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, 24020, Ranica, Bergamo, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Vasavada R, Khan S, Qiu F, Kunselman A, Ündar A. Impact of Oxygenator Selection on Hemodynamic Energy Indicators Under Pulsatile and Nonpulsatile Flow in a Neonatal Extracorporeal Life Support Model. Artif Organs 2011; 35:E101-7. [DOI: 10.1111/j.1525-1594.2011.01206.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Vasavada R, Feng Qiu, Ündar A. Current status of pediatric/neonatal extracorporeal life support: clinical outcomes, circuit evolution, and translational research. Perfusion 2011; 26:294-301. [DOI: 10.1177/0267659111401673] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extracorporeal life support (ECLS) offers lifesaving mechanical circulatory support for patients afflicted with respiratory and/or cardiac failure. Neonatal respiratory patients have higher survival rates compared to pediatric patients, while, for cardiac cases, pediatric patients are more likely to survive. The indications for ECLS have been expanded due to the improved technology and favorable outcomes. However, the rate of mortality and morbidity for ECLS patients remains significant. Mechanical complications still comprise a large percentage of ECLS complications, leaving definite room for improvement in ECLS circuit technology in the future. As a pre-clinical evaluating tool, translational research will provide more useful information for the selection of ECLS devices, encourage further development of ECLS technology, and, ultimately, benefit the patients.
Collapse
Affiliation(s)
- Rahul Vasavada
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Feng Qiu
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA, Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA, Department of Bioengineering, Penn State Milton S. Hershey Medical Center, Penn State Hershey
| |
Collapse
|
44
|
Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Gerlach H, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine 2010: III. ARDS and ALI, mechanical ventilation, noninvasive ventilation, weaning, endotracheal intubation, lung ultrasound and paediatrics. Intensive Care Med 2011; 37:394-410. [PMID: 21290103 PMCID: PMC3042109 DOI: 10.1007/s00134-011-2136-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/19/2011] [Indexed: 01/10/2023]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|