August 1994

Risk Factors for Bronchopulmonary Dysplasia After Extracorporeal Membrane Oxygenation

Author Affiliations

From the Departments of Pediatrics (Drs Kornhauser, Baumgart, and Spitzer, and Mr Cullen), Information Systems (Ms McKee), and Radiology (Dr Gross), Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pa.

Arch Pediatr Adolesc Med. 1994;148(8):820-825. doi:10.1001/archpedi.1994.02170080050008

Objective:  To determine risk factors for the development of bronchopulmonary dysplasia (BPD) after treatment with extracorporeal membrane oxygenation (ECMO).

Design:  Retrospective case-control study.

Setting:  Tertiary care level 3 neonatal intensive care unit.

Participants:  Seventy-three newborns treated with ECMO for severe respiratory failure during a 5-year period, who survived until day of life 28, and who did not have pulmonary hypoplasia as the initial cause for respiratory failure.

Interventions:  None.

Main Outcome Measure:  The presence of BPD after treatment with ECMO, which was defined as oxygen and/or ventilatory requirements at day of life 28, with characteristic abnormalities seen on chest x-ray film.

Results:  The age at ECMO initiation was significantly greater for patients with BPD compared with patients without BPD (mean±SD, 135±68 hours vs 50±37 hours; P<.001). There was an 11.5-fold increased risk for the development of BPD if ECMO was initiated at greater than 96 hours of age. The primary diagnosis of respiratory distress syndrome imparted a 5.2-fold increased risk for the development of BPD. Patients with BPD required ECMO significantly longer than patients without BPD (203±73 hours vs 122±51 hours; P<.001).

Conclusion:  These results demonstrate that delayed use of ECMO in treating neonatal respiratory failure is associated with an increased risk for the development of BPD and a longer duration of ECMO therapy.(Arch Pediatr Adolesc Med. 1994;148:820-825)