The impact and outcome of the presence of ductus arteriosus in neonatal peripheral extracorporeal membrane oxygenation.

BACKGROUND

This study aimed to investigate the impact of the patent ductus arteriosus (DA) on pulmonary conditions and to evaluate the outcomes during neonatal extracorporeal membrane oxygenation (ECMO).

METHODS

Thirteen neonates who received ECMO support at Kaohsiung Chang Gung Memorial Hospital from June 2009 to June 2021 were retrospectively reviewed. Clinical data including diagnosis, duration of ECMO support, serial chest X-rays, echocardiography findings, and outcomes were recorded. The study population underwent peripheral ECMO placement, and echocardiography was performed to assess the DA condition. Chest X-rays were evaluated using the Radiographic Assessment of Lung Edema (RALE) score to assess pulmonary edema. Statistical analyses were conducted to compare pre- and post-ECMO pulmonary conditions and outcomes.

RESULTS

The study population consisted of neonates diagnosed with congenital diaphragmatic hernia (CDH), acute respiratory distress syndrome (ARDS), or meconium aspiration syndrome (MAS). All neonates presented with pulmonary hypertension and patent DA before ECMO initiation, which DA spontaneously closed in surviving neonates after ECMO. The RALE score showed no significant differences in pulmonary edema between pre-ECMO and post-ECMO setup. The overall survival rate of neonates undergoing ECMO support with DA was 53.8 %. The ECMO weaning success rates and survival-to-discharge rates were 62.5 % and 50.0 % in the CDH group, compared to 80 % and 60 % in the non-CDH group, respectively.

CONCLUSION

The presence of DA during neonatal ECMO may not deteriorate the condition of pulmonary hypertension and pulmonary edema. Additionally, all surviving neonates showed spontaneous closure of the DA during follow-up. These findings suggest that peripheral ECMO without routine PDA ligation may be feasible in newborns.