Neonatal ECMO in Severe Bronchiolitis: Our Experience in the Last 10 Years.

Abstract

Introduction: Bronchiolitis is the most common lower respiratory tract infection in infants less than 1 year of age, and the leading cause of hospitalization in this age group in developed countries. Neonates with bronchiolitis usually have a favorable prognosis, but preterm infants due their immaturity sometimes they undergo progressive and rapid deterioration with failure of the standard respiratory support and may require rescue treatment with extracorporeal membrane oxygenation (ECMO). Materials and Methods Observational, retrospective and single-center study conducted in the neonatology department of a high-complexity hospital (Level IIIC). The study included patients admitted to the Neonatal Intensive Care Unit who required ECMO for severe respiratory failure due to acute bronchiolitis between 2013 and 2022. Results 6 patients were included, 83.3% preterm with a median gestational age of 28.6 weeks (IQR 27.1–29.6)). 3 patients (50%) presented with community bronchiolitis, and 3 (50%) with nosocomial bronchiolitis. RSV was isolated in 4 patients, rhinovirus in one and influenza A in another. The median duration of mechanical ventilation before ECMO was 2.5 days (IQR 1–4). At the beginning of ECMO support, the median age was 48.5 days (IQR 34–120), with a median postmenstrual age of 38 weeks (IQR 35-41.8) and a median weight of 2490 grams (IQR 1800–2900). The median duration of ECMO therapy was 14 days (IQR 9–24). 2 patients (33%) died, one from cardiac arrest due to hemopericardium and the other from liver failure with severe coagulopathy. All surviving patients were followed up by pulmonology and neurology. 2 (33.3%) required home oxygen therapy, and both had a respiratory admission in the first year of life. One required bronchodilator treatment, and the other has had a good evolution. One patient was diagnosed with attention deficit hyperactivity disorder, one with autism spectrum disorder and another with mild cognitive retardation and deafness. Conclusion Small infants are at high risk of developing severe bronchiolitis. Although they usually have good outcomes, some cases with the most severe respiratory failure may require rescue treatment with ECMO. When ECMO was needed, an increased mortality rate of 33% was observed, and it was associated with RSV-Bronchiolitis, prematurity, and prolonged ECMO .