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Editorial

Published:November 16, 2022DOI:https://doi.org/10.1016/j.siny.2022.101400
      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 [
      • Fletcher K.L.
      • Chapman R.
      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 [
      • Rose A.T.
      • Keene S.
      Changing populations being treated with ECMO in the neonatal period – who are the others?.
      ]. 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.
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      References

        • Fletcher K.L.
        • Chapman R.
        Update on pre-ECMO evaluation and treatment for term infants in respiratory failure.
        Semin Fetal Neonatal Med. 2022; (In this issue)
        • Rose A.T.
        • Keene S.
        Changing populations being treated with ECMO in the neonatal period – who are the others?.
        Semin Fetal Neonatal Med. 2022; (In this issue)
        • Wild K.T.
        • Mesas Burgos C.
        • Rintoul N.E.
        Expanding neonatal ECMO criteria: when is the premature neonate too premature.
        Semin Fetal Neonatal Med. 2022; (In this issue)
        • Jensen A.R.
        • Davis C.
        • Gray B.W.
        Cannulation and decannulation techniques for neonatal ECMO.
        Semin Fetal Neonatal Med. 2022; (In this issue)
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        • Herrera G.
        Coagulation and hemolysis complications in neonatal ECLS: role of devices.
        Semin Fetal Neonatal Med. 2022; (In this issue)
        • Danzer E.
        • Rintoul N.E.
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        Prenatal management of congenital diaphragmatic hernia.
        Semin Fetal Neonatal Med. 2022; (In this issue)
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        Management of the CDH patient on ECLS.
        Semin Fetal Neonatal Med. 2022; (In this issue)
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        Milestones for clinical translation of the artificial placenta.
        Semin Fetal Neonatal Med. 2022; (In this issue)
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        Semin Fetal Neonatal Med. 2022; (In this issue)