As with all medical advancements, there are key individuals and multidisciplinary
research and medical teams involved in directing these new therapies forward. The
development of therapeutic modalities for infants in respiratory failure is an excellent
example of this team approach. In this issue of Seminars in Fetal & Neonatal Medicine
we have assembled nine chapters written by such collaborators and experts in treatment
of these complex infants, with a focus on the use of neonatal extracorporeal life
support (ECLS) in this population. ECLS therapy is also one of the leading examples
of a multidisciplinary team approach to a therapy, involving medical, surgical, nursing,
respiratory therapists, and perfusion experts in the development and expansion of
this life saving procedure. Our first chapter by Drs. Chapman and Fletcher [
Update on pre-ECMO evaluation and treatment for term infants in respiratory failure.
], is a comprehensive overview of the therapies available for respiratory failure
available before extracorporeal membrane oxygenation (ECMO) is considered, including
a look into future therapies that may show promise in improving outcomes. Inhaled
nitric oxide and other vasoactive agents have reduced the need for ECMO in many infants
with straightforward pulmonary hypertension, shifting the populations requiring ECMO
to the more complex disorders in this population. An extensive overview of these complex
patients, including newer therapies and outcome related to their underlying disorder
is covered in the chapter by Drs. Keene and Rose [
Changing populations being treated with ECMO in the neonatal period – who are the
]. With improvements in equipment, technical support, and coagulation management in
ECLS, many have re-examined the populations treated and are recommending consideration
for allowing criteria to be expanded to include the more premature infant, present
criteria are ≥34 weeks of gestation. The data supporting this consideration are discussed
in the chapter by Drs Wild et al. [
- Wild K.T.
- Mesas Burgos C.
- Rintoul N.E.
Expanding neonatal ECMO criteria: when is the premature neonate too premature.
] directing the neonatal and ECMO community to consider a national/international discussion
on this concept.