Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for neonates with respiratory failure or congenital cardiac disease refractory to maximal medical management. Early studies showed high rates of mortality and morbidities among preterm and low birthweight (BW) neonates, leading to widely accepted ECMO inclusion criteria of gestational age (GA) ≥34 weeks and BW >2 kg. In recent years, publications involving neonates of 32–34 weeks GA have reported improved survival and decreased intracranial hemorrhage. As such, ECMO should be considered on a case-by-case basis in premature neonates as long as the risks are understood.

1.
Hardart
GE
,
Hardart
MK
,
Arnold
JH
.
Intracranial hemorrhage in premature neonates treated with extracorporeal membrane oxygenation correlates with conceptional age
.
J Pediatr
.
2004
;
145
(
2
):
184
9
.
2.
Cilley
RE
,
Zwischenberger
JB
,
Andrews
AF
,
Bowerman
RA
,
Roloff
DW
,
Bartlett
RH
.
Intracranial hemorrhage during extracorporeal membrane oxygenation in neonates
.
Pediatrics
.
1986
;
78
(
4
):
699
704
.
3.
Bartlett
RH
,
Gazzaniga
AB
,
Toomasian
J
,
Coran
AG
,
Roloff
D
,
Rucker
R
.
Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. 100 cases
.
Ann Surg
.
1986
;
204
(
3
):
236
45
.
4.
Revenis
ME
,
Glass
P
,
Short
BL
.
Mortality and morbidity rates among lower birth weight infants (2000 to 2500 grams) treated with extracorporeal membrane oxygenation
.
J Pediatr
.
1992
;
121
(
3
):
452
8
.
5.
Cairo
SB
,
Arbuthnot
M
,
Boomer
LA
,
Dingeldein
MW
,
Feliz
A
,
Gadepalli
S
, et al
Controversies in extracorporeal membrane oxygenation (ECMO) utilization and congenital diaphragmatic hernia (CDH) repair using a Delphi approach: from the American Pediatric Surgical Association Critical Care Committee (APSA-CCC)
.
Pediatr Surg Int
.
2018
;
34
(
11
):
1163
9
.
6.
Hirschl
RB
,
Schumacher
RE
,
Snedecor
SN
,
Bui
KC
,
Bartlett
RH
.
The efficacy of extracorporeal life support in premature and low birth weight newborns
.
J Pediatr Surg
.
1993
;
28
(
10
):
1336
40
.
7.
Church
JT
,
Kim
AC
,
Erickson
KM
,
Rana
A
,
Drongowski
R
,
Hirschl
RB
, et al
Pushing the boundaries of ECLS: outcomes in <34 week EGA neonates
.
J Pediatr Surg
.
2017
;
52
(
11
):
1810
5
.
8.
Ramachandrappa
A
,
Rosenberg
ES
,
Wagoner
S
,
Jain
L
.
Morbidity and mortality in late preterm infants with severe hypoxic respiratory failure on extra-corporeal membrane oxygenation
.
J Pediatr
.
2011
;
159
(
2
):
192
8.e3
.
9.
Rozmiarek
AJ
,
Qureshi
FG
,
Cassidy
L
,
Ford
HR
,
Gaines
BA
,
Rycus
P
, et al
How low can you go? Effectiveness and safety of extracorporeal membrane oxygenation in low-birth-weight neonates
.
J Pediatr Surg
.
2004
;
39
(
6
):
845
7
.
10.
Bahrami
KR
,
Van Meurs
KP
.
ECMO for neonatal respiratory failure
.
Semin Perinatol
.
2005
;
29
(
1
):
15
23
.
11.
Delaplain
PT
,
Zhang
L
,
Chen
Y
,
Nguyen
DV
,
Di Nardo
M
,
Cleary
JP
, et al
Cannulating the contraindicated: effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation
.
J Pediatr Surg
.
2017
;
52
(
12
):
2018
25
.
12.
Ali
K
,
Grigoratos
D
,
Cornelius
V
,
Davenport
M
,
Nicolaides
K
,
Greenough
A
.
Outcome of CDH infants following fetoscopic tracheal occlusion: influence of premature delivery
.
J Pediatr Surg
.
2013
;
48
(
9
):
1831
6
.
13.
Tsao
K
,
Allison
ND
,
Harting
MT
,
Lally
PA
,
Lally
KP
.
Congenital diaphragmatic hernia in the preterm infant
.
Surgery
.
2010
;
148
(
2
):
404
10
.
14.
Danzer
E
,
Hoffman
C
,
D‘Agostino
JA
,
Gerdes
M
,
Bernbaum
J
,
Antiel
RM
, et al
Neurodevelopmental outcomes at 5 years of age in congenital diaphragmatic hernia
.
J Pediatr Surg
.
2017
;
52
(
3
):
437
43
.
15.
Cuevas Guamán
M
,
Akinkuotu
AC
,
Cruz
SM
,
Griffiths
PA
,
Welty
SE
,
Lee
TC
, et al
Extracorporeal membrane oxygenation in premature infants with congenital diaphragmatic hernia
.
ASAIO J
.
2018
;
64
(
5
):
e126
9
.
16.
Guner
YS
,
Khemani
RG
,
Qureshi
FG
,
Wee
CP
,
Austin
MT
,
Dorey
F
, et al
Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation
.
J Pediatr Surg
.
2009
;
44
(
9
):
1691
701
.
17.
McNally
H
,
Bennett
CC
,
Elbourne
D
,
Field
DJ
.
United Kingdom collaborative randomized trial of neonatal extracorporeal membrane oxygenation: follow-up to age 7 years
.
Pediatrics
.
2006
;
117
:
e845
54
.
18.
Madderom
MJ
,
Reuser
JJ
,
Utens
EM
,
van Rosmalen
J
,
Ma Raets
M
,
Govaert
P
, et al
Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study
.
Intensive Care Med
.
2013
;
39
:
15841593
.
19.
Hee Chung
E
,
Chou
J
,
Brown
K
.
Neurodevelopmental outcomes of preterm infants: a recent literature review
.
Transl Pediatr
.
2020
;
9
(
Suppl 1
):
S3
8
.
20.
Partridge
EA
,
Davey
MG
,
Hornick
MA
,
Flake
AW
.
An EXTrauterine environment for neonatal development: EXTENDING fetal physiology beyond the womb
.
Semin Fetal Neonatal Med
.
2017
;
22
(
6
):
404
9
.
21.
Church
JT
,
Coughlin
MA
,
Perkins
EM
,
Hoffman
HR
,
Barks
JD
,
Rabah
R
, et al
The artificial placenta: continued lung development during extracorporeal support in a preterm lamb model
.
J Pediatr Surg
.
2018
;
53
(
10
):
1896
903
.
22.
Partridge
E
,
Davey
M
,
Hornick
M
,
Dysart
K
,
Olive
A
,
Caskey
R
, et al
Pumpless arteriovenous extracorporeal membrane oxygenation: a novel mode of respiratory support in a lamb model of congenital diaphragmatic hernia
.
J Pediatr Surg
.
2018
;
53
(
8
):
1453
60
.
23.
Hibbs
A
,
Evans
JR
,
Gerdes
M
,
Hunter
JV
,
Cullen
JA
.
Outcome of infants with bronchopulmonary dysplasia who receive extracorporeal membrane oxygenation therapy
.
J Pediatr Surg
.
2001
;
36
(
10
):
1479
84
.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.