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Impact of new treatments for neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome.
J Perinatol. 1997 Sep-Oct; 17(5):366-9.JP

Abstract

OBJECTIVE

To determine the impact of new treatment modalities, including high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (INO), on extracorporeal membrane oxygenation (ECMO) use and outcome of neonatal patients with persistent pulmonary hypertension of the newborn.

STUDY DESIGN

We reviewed the medical records of neonatal patients meeting established ECMO criteria from 1988 to 1995. Clinical data were gathered from this retrospective chart review. Comparison of ECMO experiences were made between the 1988-90 period (pre-HFOV and INO, or period 1) and the 1993-95 period (HFOV and INO fully established as treatment modalities, or period 2).

RESULTS

One hundred three patients were treated with ECMO during the 8-year study period. After HFOV and INO were introduced in 1991 and 1992 respectively, the number of patients meeting established ECMO criteria who subsequently required ECMO therapy progressively declined, from 22.3 +/- 2.3 (mean +/- SD) patients per year during period 1 to 12 patients in 1991 when HFOV was introduced, 8 patients in 1992 when INO was introduced, and 5.3 +/- 2.9 patients per year in period 2. The number of patients referred for ECMO over time did not change. Survival after ECMO dropped from 84% during period 1 to 56% in period 2. Introduction of new pre-ECMO therapies has not delayed institution of ECMO, significantly increased the length of ECMO runs, or lengthened the hospital course of ECMO survivors. A comparison of the eight infants treated with ECMO in 1992 with the 10 infants treated with INO in 1993 showed a longer hospital stay and a larger average patient bill for the patients treated with ECMO.

CONCLUSION

New treatment approaches for severe persistent pulmonary hypertension have reduced ECMO use, shortened the duration of hospitalization, and reduced costs for those infants responding to HFOV and INO. However, survival of patients requiring ECMO therapy has decreased.

Authors+Show Affiliations

Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9373841

Citation

Kennaugh, J M., et al. "Impact of New Treatments for Neonatal Pulmonary Hypertension On Extracorporeal Membrane Oxygenation Use and Outcome." Journal of Perinatology : Official Journal of the California Perinatal Association, vol. 17, no. 5, 1997, pp. 366-9.
Kennaugh JM, Kinsella JP, Abman SH, et al. Impact of new treatments for neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. J Perinatol. 1997;17(5):366-9.
Kennaugh, J. M., Kinsella, J. P., Abman, S. H., Hernandez, J. A., Moreland, S. G., & Rosenberg, A. A. (1997). Impact of new treatments for neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. Journal of Perinatology : Official Journal of the California Perinatal Association, 17(5), 366-9.
Kennaugh JM, et al. Impact of New Treatments for Neonatal Pulmonary Hypertension On Extracorporeal Membrane Oxygenation Use and Outcome. J Perinatol. 1997 Sep-Oct;17(5):366-9. PubMed PMID: 9373841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of new treatments for neonatal pulmonary hypertension on extracorporeal membrane oxygenation use and outcome. AU - Kennaugh,J M, AU - Kinsella,J P, AU - Abman,S H, AU - Hernandez,J A, AU - Moreland,S G, AU - Rosenberg,A A, PY - 1997/11/28/pubmed PY - 1997/11/28/medline PY - 1997/11/28/entrez SP - 366 EP - 9 JF - Journal of perinatology : official journal of the California Perinatal Association JO - J Perinatol VL - 17 IS - 5 N2 - OBJECTIVE: To determine the impact of new treatment modalities, including high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (INO), on extracorporeal membrane oxygenation (ECMO) use and outcome of neonatal patients with persistent pulmonary hypertension of the newborn. STUDY DESIGN: We reviewed the medical records of neonatal patients meeting established ECMO criteria from 1988 to 1995. Clinical data were gathered from this retrospective chart review. Comparison of ECMO experiences were made between the 1988-90 period (pre-HFOV and INO, or period 1) and the 1993-95 period (HFOV and INO fully established as treatment modalities, or period 2). RESULTS: One hundred three patients were treated with ECMO during the 8-year study period. After HFOV and INO were introduced in 1991 and 1992 respectively, the number of patients meeting established ECMO criteria who subsequently required ECMO therapy progressively declined, from 22.3 +/- 2.3 (mean +/- SD) patients per year during period 1 to 12 patients in 1991 when HFOV was introduced, 8 patients in 1992 when INO was introduced, and 5.3 +/- 2.9 patients per year in period 2. The number of patients referred for ECMO over time did not change. Survival after ECMO dropped from 84% during period 1 to 56% in period 2. Introduction of new pre-ECMO therapies has not delayed institution of ECMO, significantly increased the length of ECMO runs, or lengthened the hospital course of ECMO survivors. A comparison of the eight infants treated with ECMO in 1992 with the 10 infants treated with INO in 1993 showed a longer hospital stay and a larger average patient bill for the patients treated with ECMO. CONCLUSION: New treatment approaches for severe persistent pulmonary hypertension have reduced ECMO use, shortened the duration of hospitalization, and reduced costs for those infants responding to HFOV and INO. However, survival of patients requiring ECMO therapy has decreased. SN - 0743-8346 UR - https://www.unboundmedicine.com/medline/citation/9373841/Impact_of_new_treatments_for_neonatal_pulmonary_hypertension_on_extracorporeal_membrane_oxygenation_use_and_outcome_ L2 - http://www.diseaseinfosearch.org/result/6088 DB - PRIME DP - Unbound Medicine ER -