INTRODUCTION: Venovenous (VV) extracorporpeal life support has provided an alternative therapy which is less invasive than venoarterial (VA) bypass. Although many centers use VV bypass when a neonate has reasonably normal heart function, there are few data concerning outcomes of infants so treated. We performed this investigation to compare outcomes in a large series of infants managed with VV compared to VA bypass. METHODS: From 1985 to mid-1992, we exclusively used VA bypass at our institution. However, since mid-1992, we have initiated VV bypass in 43% of all neonates needing ECLS. We reviewed the records of the VV-treated group to ascertain: diagnoses, survival rates, hours on bypass, brain lesions and their laterality on neuroimaging(all neonates had head ultrasound and MRI evaluations), as well as neurodevelopmental testing at 12 months of age (Bayley Scales of Infant Development-II [BSID-II]). We compared these infants with all non-CDH patients treated with VA bypass at our center from 1985-1995. CDH patients were excluded because of their typically longer bypass times and lower survival rates. RESULTS: 55 neonates were initially managed with VV bypass. Their diagnoses included MAS (33), sepsis/pneumonia (n=10), idiopathic PPHN (n=5), RDS (n=3), cardiac (n=3), and non-immune hydrops (n=1). 4/55 (7%) of the VV infants were subsequently converted to VA bypass because of deteriorating status. We compared the remaining 51 VV-treated neonates to the VA population (n=197) which consisted of 115 MAS, 25 PPHN, 34 RDS, and 23 with sepsis/pneumonia. 175/197 (89%) VA infants survived compared to 49/51 (96%) VV subjects (P=0.113). Duration of bypass was significantly longer among VA-treated neonates (median 130 compared to 103 hours, P=0.0027). 43/197 (22%) VA infants suffered major intracranial lesions (parenchymal bleeds, infarcts, or marked atrophy) compared to 14/51 (27%) VV infants (no significant difference). There was no laterality of lesions noted in either group(10 R, 14 L, 19 bilaeral in VA infants versus6 R, 3 L, and 5 bilateral in VV infants). On the BSID-II, surviving VA patients had median 12 month scores of 98 MDI, 91 PDI compared to the VV infants' median scores of105 MDI, 94 PDI (no significant differences).CONCLUSIONS: Compared to those managed with VA ECLS, infants treated with VV bypass have a shorter duration of therapy, have no differences in major brain lesions, and appear to do at least as well on subsequent neurodevelopmental testing.
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Journal of Pediatric Surgery (1998)