Among infants ≥28 weeks' gestational age, HHHFNC appears to have similar efficacy and safety to nCPAP when applied immediately postextubation or early as initial noninvasive support for respiratory dysfunction.

The "10-Q" for review/position paper on how inter-hospital transports on Extracorporeal membrane oxygenation (ECMO) is performed and organized in different health care systems in different parts of the world. How is the suggestion from to the ECMONet (Combes et al 2014) regarding the Hub-and-Spoke model with the larger ECMO centre in the middle who provide the service performing as compared to other models, for example Japan with multiple ECMO centers all doing their own transfers (?), or United Kingdom who transfer to five major hospital for adult ECMO.This study is an investigation planned and designed by the ECMO European Advisory Board (EEAB), an independent consortium for the development and research in all matters related to Extracorporeal membrane oxygenation.

The objectives of this study are to compare the neonatal risks and benefits of antenatal single-course versus repeated-course corticosteroids in singleton and multiple-gestation pregnancies. A comprehensive analysis was performed of the inpatient records of all neonates admitted to our center from 1 January 1994 through 31 May 1999. The primary outcome measure was survival without chronic lung disease (CLD). Secondary outcome measures included birth weight; head circumference; interval weight ratios; respiratory disease severity; intraventricular hemorrhage rate and severity; severe retinopathy of prematurity; early infection; and hospital days. All singletons 27-32 completed weeks' gestation, and multiples 26-32 weeks' gestation, whose mothers had received betamethasone before delivery, were included. One hundred and fifteen singleton and 53 multiple-gestation infants (total 168) were stratified by multiplicity, gestational-age (< or =29 or > or =30 weeks), and number of steroid courses. Repeated courses of antenatal betamethasone were not associated with greater survival without CLD, in either singleton- or multiple-gestation infants. In singletons there was no difference in any outcome measure between groups. In multiples, the only difference was greater postnatal weight gain in the lower gestation group. Mean birth head circumference was smaller in repetitively-treated singletons < or =29 weeks. There are no clinically significant neonatal benefits of repeated-course antenatal steroids in singletons > or =27 weeks estimated gestational age (EGA) or multiple-gestation infants > or =26 weeks EGA. Prospective randomized trials of single-course versus repetitive antenatal corticosteroid therapy are warranted.

Objective Describe practice variations in ventilator strategies used for lung rest during extracorporeal membrane oxygenation (ECMO) for respiratory failure in neonates, and assess the potential impact of various lung rest strategies on the duration of ECMO and the duration of mechanical ventilation after decannulation. Data Source Retrospective cohort analysis from the extracorporeal life support organization (ELSO) registry database during the years 2008–2013. Study selection All ECMO runs for infants ≤ 30 days of life for pulmonary reasons were included. Data extraction Ventilator type and ventilator settings used for lung rest at 24 hours after ECMO initiation were obtained. Results A total of 3,040 cases met inclusion criteria. Conventional mechanical ventilation (CMV) was used for lung rest in 88% of cases and high frequency ventilation (HFV) was used in 12%. In the CMV group, 32% used positive end expiratory pressure (PEEP) strategy of 4–6 cm H2O (low), 22% used 7–9 cm H2O (mid) and 43% used 10–12 cm H2O (high). HFV was associated with an increased mean (SEM) hours of ECMO [150.2 (0.05) vs. 125 (0.02); p < 0.001] and an increased mean (SEM) hours of mechanical ventilation after decannulation [135 (0.09) vs. 100.2 (0.03); p = 0.002], compared with CMV among survivors. Within the CMV group, use of higher PEEP was associated with a decreased mean (SEM) hours of ECMO [high vs. low: 136 (1.06) vs. 156 (1.06), p = 0.001; mid vs. low: 141 (1.06) vs. 156 (1.06); p = 0.04] but increased duration of mechanical ventilation after decannulation in the high PEEP group compared with low PEEP (p= 0.04) among survivors. Conclusions Wide practice variation exists with regard to ventilator settings used for lung rest during neonatal respiratory ECMO. Use of HFV as compared to CMV and use of low PEEP strategy as compared to mid PEEP and high PEEP strategy is associated with longer duration of ECMO. Further research to provide evidence to drive optimization of pulmonary management during neonatal respiratory ECMO is warranted.

Extracorporeal membrane oxygenation (ECMO) is used for cardiopulmonary dysfunction. Hepatopulmonary syndrome (HPS) occurs in the setting of liver failure and may cause hypoxemia. Previous reports have described the use of ECMO for HPS after liver transplant. Our patient is a 19-month-old female with biliary atresia, an interrupted inferior vena cava, and HPS on 8 liters per minute of high-flow oxygen. Following liver transplantation, her postoperative course was complicated by severe hypoxemia requiring ECMO. Due to her interrupted inferior vena cava, our standard bi-caval cannula could not be used. Hence, a 16-French double lumen venovenous right internal jugular to right atrial cannula was used to provide extracorporeal life support. She was decannulated after 17 days, remained intubated for 2 days, and weaned to room air over the next 3 weeks. This is the third pediatric liver transplant patient supported with ECMO identified in the literature, and the youngest and smallest of those reported. This approach to cannulation is unique because of the use of a double lumen venovenous cannula for HPS in a child, selected due to complex anatomy. Posttransplant ECMO may provide pediatric patients with HPS and posttransplant hypoxemia a period of support for their pulmonary remodeling and recovery from HPS.

Extracorporeal membrane oxygenation (ECMO) is used in patients with acute respiratory failure that is not responsive to conventional management. The practice of awake ECMO has become an area of interest but with limited data and experience. Most reported experience comes from adult and pediatric populations. Traditional management of these patients still includes mechanical ventilator support and often requires the use of sedatives for provision of safe care. We present a series of eight neonates who were electively extubated while on ECMO, with expanded discussion of two representative cases. We discuss the rationale for extubation and outcomes. The greatest benefit of this management was seen in patients with significant air leak, and in no reported case did we experience any adverse effects or complications as a direct result of extubation while on ECMO. In conclusion, in our experience, awake neonatal ECMO appears safe and effective and may offer significant advantages over traditional management in certain clinical scenarios. Prospective comparison trials are warranted to further investigate the clinical benefits and risks of awake neonatal ECMO.

BACKGROUND: Blood transfusions in the neonatal patient population are common, but there are no established guidelines regarding transfusion thresholds. Little is known about postoperative outcomes in neonates who receive preoperative blood transfusions (PBTs).METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Data Files from 2012 to 2015, we identified all neonates who underwent surgery. Mortality and composite morbidity (defined as any postoperative complication) in neonates who received a PBT within 48 hours of surgery were compared with that in neonates who did not receive a transfusion.RESULTS: A total of 12 184 neonates were identified, of whom 1209 (9.9%) received a PBT. Neonates who received a PBT had higher rates of preoperative comorbidities and worse postoperative outcomes when compared with those who did not receive a transfusion (composite morbidity: 46.2% vs 16.2%; P , .01). On multivariable regression analysis, PBTs were independently associated with increased 30-day morbidity (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 1.63-2.22; P , .01) and mortality (OR = 1.98; 95% CI: 1.55-2.55; P , .01). In a propensity score-matched analysis, PBTs continued to be associated with increased 30-day morbidity (

OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) systems have continued to evolve and improve with the development of smaller and portable systems. The Cardiohelp (Maquet Getinge Cardiopulmonary AG, Rastatt, Germany) portable life support device is a compact ECMO system used widely in adults and for ECMO transport. Reports of its use in neonatal and pediatric centers remain limited. In this single-center retrospective review, we describe our institutional experience with the Cardiohelp. DESIGN: Single-center retrospective review. SETTING:Neonatal ICUs and PICUs in a tertiary-care children's hospital. PATIENTS:Seventeen pediatric patients on ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Median (interquartile range, IQR) of patient age was 0.5 years (0-7 yr). Eleven of 17 patients were on veno-arterial ECMO, five on veno-venous ECMO, and one on veno-venoarterial ECMO. All veno-venous and veno-venoarterial runs (n = 6) were accomplished with bicaval, dual-lumen cannulae. Median duration on Cardiohelp was 113 hours (IQR 50-140 hr). Median anti-Xa level for patients was 0.43 IU/mL (IQR 0.35-0.47 IU/ mL), with median heparin dose of 23.6 U/kg/hr (IQR 17.6-28.1 U/kg/hr). Median plasma-free hemoglobin was 41.4 mg/dL (IQR 30-60 mg/dL). Circuit change was required in three cases. Fourteen patients survived ECMO, with 13 patients surviving to discharge. CONCLUSIONS:We have used the Cardiohelp system to support 17 neonatal and pediatric ECMO patients, without complications. Further studies are warranted to compare complications, outcomes, and overall cost with other institutions and other existing ECMO systems.