Clinical Programs
Acute Respiratory Support
Extracorporeal Membrane Oxygenation
Extracorporeal membrane oxygenation first became a viable treatment for severe neonatal respiratory failure in 1987. The goal of ECMO is to support tissue oxygenation in infants with severe respiratory failure due to reversible pulmonary disease. The process is to withdraw venous blood from an infant, remove carbon dioxide, add oxygen, and then return the oxygenated blood to the body.
ECMO selection criteria vary among ECMO centers. However, any criteria should determine whether the risk of severe morbidity or mortality without ECMO treatment is greater than the risk of ECMO. Typically, this involves examining arterial oxygenation in relation to the degree of respiratory support. Many centers include criteria for blood lactate levels and/or a postductal PaO2. Gestational age ≥34 weeks and weight ≥2 kg often are specified.
Exclusion criteria include
- presence of significant intracranial hemorrhage,
- uncontrolled bleeding in other locations,
- congenital anomalies or significant central nervous system dysfunction in which ECMO use would appear futile,
- congenital heart disease, or
- pulmonary disease that is not likely to be reversible. This criterion is used as the risk of hemorrhagic and other complications increases with longer ECMO runs.
Lisa M. Adcock, M.D., now heads our ECMO Program.
Inhaled Nitric Oxide
In late 1999, the US Food and Drug Administration approved nitric oxide for treatment of pulmonary hypertension in newborns 34 weeks' gestation and older. FDA approval was based on the results of several large, randomized, controlled trials that demonstrated that the use of inhaled nitric oxide in newborns with hypoxemic respiratory failure improves oxygenation and reduces the need for ECMO (heart-lung bypass). Baylor College of Medicine neonatologists participated in the first large trial, and our section treats more than 65 infants a year with inhaled nitric oxide.
iNO can produce pulmonary vasodilation in newborns with hypoxic respiratory failure. The etiologies of neonatal hypoxic respiratory failure that have been shown to respond to iNO include primary pulmonary hypertension, severe hyaline membrane disease, meconium aspiration, pneumonia, and sepsis.
Nitric oxide is considered a safe and effective alternative to ECMO in many circumstances, primarily because iNO is delivered non-invasively and easily through the ventilator circuit. However, immediate accessibility to an ECMO center must be considered when using iNO treatment since infants who do not respond to iNO may need to be quickly placed on ECMO.
