10 RESPIRATORY FAILURE REQUIRING ECMO IN NEWBORNS WITH GASTROSCHISIS: INCIDENCE AND SURGICAL OUTCOMES
Katie Russell, Michael Nance, N. Scott Adzick, Pablo Laje
Children's Hospital of Philadelphia, Philadelphia, USA

Abstract

Aim of the Study: To evaluate the incidence of respiratory failure requiring ECMO in newborns with gastroschisis (GTC), compare it to the incidence in the general population, review the surgical outcomes of newborns with GTC requiring ECMO and compare them to newborns with GTC not requiring ECMO.

Methods: Retrospective review. All neonatal admissions for GTC. December/2010 to September/2015.

Main Results: A total of 110 newborns with GTC were admitted to our NICU between 12/2010 and 9/2015; 36 were born at term. Four cases, all term, all prenatally diagnosed, all outborn, developed respiratory failure requiring ECMO, secondary to meconium aspiration syndrome (MAS) in all cases. This 11% (4 of 36 term newborns with GTC) represents a 300-fold increase in the incidence of MAS-associated respiratory failure requiring ECMO compared to the general population of term newborns (0.037%). ECMO was required within the first 12 hours of life in 3 cases and on the 5th day of life in one case. Median time on ECMO was 12 (9-20) days. All patients survived. The time to achieve full enteral feedings in the GTC/ECMO group was twice the time of the 106 newborns in the GTC/non-ECMO group (median: 69 vs. 35 days, respectively).  The time to hospital discharge was three times longer in the GTC/ECMO group compared to the GTC/non-ECMO group (median: 42 [20-282] versus 125 [69-223] days, respectively).

Conclusion: The incidence of respiratory failure requiring ECMO in term newborns with GTC is remarkably higher than in the general population of term newborns. While infrequent, the possibility of this event supports the concept that fetuses with GTC benefit from being delivered at tertiary centers with pediatric surgery and ECMO capabilities. Newborns with GTC requiring ECMO have a much longer hospital stay than newborns with GTC not requiring ECMO.


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