Cannulating the contraindicated

Effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation

Patrick T. Delaplain, Lishi Zhang, Yanjun Chen, Danh V. Nguyen, Matteo Di Nardo, John Patrick Cleary, Peter T. Yu, Yigit S. Guner

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background/purpose: Restrictions for ECMO in neonates include birth weight less than 2. kg (BW <. 2. kg) and/or gestational age less than 34. weeks (GA <. 34. weeks). We sought to describe their relationship on mortality. Methods: Neonates with a primary diagnosis code of CDH were identified in the Extracorporeal Life Support Organization (ELSO) registry, and logistic regression models were used to examine the effect of BW <. 2. kg and GA <. 34. weeks on mortality. Results: We identified 7564 neonates with CDH. The overall mortality was 50%. There was a significantly higher risk of death with unadjusted odds ratio (OR) 2.39 (95% confidence interval [CI]: 1.53-3.74; P <. 0.01) for BW <. 2. kg neonates. The adjusted OR of death for BW <. 2. kg neonates remained significantly high with over two-fold increase in the odds of mortality when adjusted for potential confounding variables (OR 2.11, 95% CI: 1.30-3.43; P <. 0.01). However, no difference in mortality was observed in neonates with GA <. 34. weeks. Conclusions: While mortality among CDH neonates with a BW <. 2. kg was substantially increased, GA <. 34. weeks was not significantly associated with mortality. Effort should be made to identify the best candidates for ECMO in this high-risk group and develop treatment strategies to optimize their survival. Type of study: Case-Control Study, Retrospective Comparative Study. Level of evidence: Level III.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Extracorporeal Membrane Oxygenation
Low Birth Weight Infant
Newborn Infant
Mortality
Odds Ratio
Logistic Models
Confidence Intervals
Confounding Factors (Epidemiology)
Congenital Diaphragmatic Hernias
Birth Weight
Gestational Age
Registries
Case-Control Studies
Retrospective Studies
Organizations

Keywords

  • CDH
  • ECMO
  • Low birthweight
  • Low gestation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Cannulating the contraindicated : Effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation. / Delaplain, Patrick T.; Zhang, Lishi; Chen, Yanjun; Nguyen, Danh V.; Di Nardo, Matteo; Cleary, John Patrick; Yu, Peter T.; Guner, Yigit S.

In: Journal of Pediatric Surgery, 2017.

Research output: Contribution to journalArticle

Delaplain, Patrick T. ; Zhang, Lishi ; Chen, Yanjun ; Nguyen, Danh V. ; Di Nardo, Matteo ; Cleary, John Patrick ; Yu, Peter T. ; Guner, Yigit S. / Cannulating the contraindicated : Effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation. In: Journal of Pediatric Surgery. 2017.
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AB - Background/purpose: Restrictions for ECMO in neonates include birth weight less than 2. kg (BW <. 2. kg) and/or gestational age less than 34. weeks (GA <. 34. weeks). We sought to describe their relationship on mortality. Methods: Neonates with a primary diagnosis code of CDH were identified in the Extracorporeal Life Support Organization (ELSO) registry, and logistic regression models were used to examine the effect of BW <. 2. kg and GA <. 34. weeks on mortality. Results: We identified 7564 neonates with CDH. The overall mortality was 50%. There was a significantly higher risk of death with unadjusted odds ratio (OR) 2.39 (95% confidence interval [CI]: 1.53-3.74; P <. 0.01) for BW <. 2. kg neonates. The adjusted OR of death for BW <. 2. kg neonates remained significantly high with over two-fold increase in the odds of mortality when adjusted for potential confounding variables (OR 2.11, 95% CI: 1.30-3.43; P <. 0.01). However, no difference in mortality was observed in neonates with GA <. 34. weeks. Conclusions: While mortality among CDH neonates with a BW <. 2. kg was substantially increased, GA <. 34. weeks was not significantly associated with mortality. Effort should be made to identify the best candidates for ECMO in this high-risk group and develop treatment strategies to optimize their survival. Type of study: Case-Control Study, Retrospective Comparative Study. Level of evidence: Level III.

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