Presented at the Neonatal Society 2001 Summer Meeting.
Bennett CC1, Johnson A2, Field DJ3.
On behalf of the UK Collaborative ECMO Trial Group.
1 John Radcliffe Hospital, Oxford, UK
2 NPEU, University of Oxford, UK
3 Leicester University, Leicester, UK
Objective: To determine clinical variables predicting outcome in a group of 185 infants born at 35 weeks gestational age or above who developed severe respiratory failure defined by oxygenation index equal to or greater than 40.
Methods: A variety of disease severity markers were selected and the association between the chosen variable and outcome was determined. Adverse outcome was defined by death or disability at four years of age in survivors. Receiver operator characteristic (ROC) plots were constructed for variables with continuous data and relative risk (RR) with 95% confidence intervals (CI) calculated for binominal data.
Results: Clinical variables predicting mortality and disability at 4 years:
| Clinical variable Congenital diaphragmatic hernia Birthweight less than 3kg Continued conventional care, ie. not ECMO | RR (95% CI), p value 1.38 (1.22-1.56), p<0.001 1.34 (1.16-1.54), p<0.001 1.84 (1.14-2.97), p=0.003 |
Clinical variables predicting disability at 4 years in survivors:
| Clinical variable Seizures requiring treatment Sepsis – documented or suspected Full sucking feeding at over 14 days of age Days in hospital over 30 days Supplementary oxygen at discharge | RR (95% CI), p value 2.02 (1.63-2.51), p=0.002 1.58 (1.09-2.30), p=0.01 6.47 (2.24-19.2), p<0.001 1.79 (1.22-2.61), p=0.02 1.91 (1.57-2.34), p=0.02 |
Conclusions: This study has identified clinical variables that predict adverse outcome for term infants with severe respiratory failure. The results could assist clinicians caring for these babies and when counselling their families.