Extracorporeal Membrane Oxygenation Incidence, Characteristics, and Outcomes in Neonatal Down Syndrome Patients

Abstract

Practice patterns for extracorporeal membrane oxygenation (ECMO) use in newborns with Trisomy 21 (T21) have not been fully reported. The goals of this study were to 1) determine the incidence of ECMO use in T21 neonates; 2) identify clinical and demographic characteristics associated with ECMO use in this population; 3) describe outcomes of neonates with T21 supported with ECMO. This was a retrospective cohort study using the Pediatric Health Information System database (January 2000 to January 2014). Given the exploratory nature, only descriptive statistics were used. p < 0.05 was considered significant. Within 43 pediatric hospitals, the incidence of ECMO use in neonates with T21 was 2.3% (131/5,737). Neonates with T21 supported with ECMO were more likely to be admitted earlier; have higher birth weight, gestational age, and longer hospitalization; and have congenital diaphragmatic hernia or select cardiac anomalies versus those who did not require ECMO. T21 neonates supported with ECMO also had higher incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, and mortality (unadjusted odds ratio 12.3 [95% confidence interval: 8.6-17.6]) compared with T21 neonates not exposed to ECMO. Compared with T21 neonates not requiring ECMO, those supported with ECMO had increased morbidity and mortality. Additional investigation on timing, indications, and risk/benefit profiles, for ECMO use in T21 neonates is needed.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Race and/or ethnicity was the primary study aim in five citations (13%). No statistical difference or mixed results were observed in 25 (64%) of studies (51, 52, 135–147). Studies with cardiac disease, arrest, transplant, or shock observed patients from diverse backgrounds having lower ECMO use in seven (28, 31, 129, 148–151) versus higher ECMO use in three (26, 89, 152).…”

Cardiovascular Complications of Down Syndrome: Scoping Review and Expert Consensus

“… 38 Neonates with DS more frequently require mechanical ventilation and extracorporeal membrane oxygenation (ECMO; needed in 2.3% of neonates with DS in 1 study of 5737 newborns in 43 centers across the United States). 40 …”

Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Adult Patients With Down Syndrome

“…As stated before, patients with DS have multiple medical issues, especially cardiac and respiratory (9,14,20), that usually need to be addressed in the pediatric time period. Significant pulmonary hypertension or recovery from cardiac surgery place the pediatric DS population at a higher risk for ECMO use (17,21,22). By the time these patients reach adulthood, these issues have likely abated, been minimized with treatment, or no longer require major cardiac surgery such that the risk for ECMO use is significantly less than in the pediatric population.…”

“…Extracorporeal membrane oxygenation (ECMO) is a form of mechanical support that may be used to support patients with refractory respiratory or cardiac failure. ECMO use has been described for neonates and pediatric patients with DS who are severely ill (17)(18)(19)(20)(21)(22). Pediatric patients with DS appear to have increased prevalence of ECMO support compared to the general population (22).…”