Use of extracorporeal membrane oxygenation in neonates with severe bronchiolitis: Our experience over the last 10 years

BackgroundBronchiolitis is the most common lower respiratory tract infection in infants under 1 year of age. Although outcomes are generally good in neonates, preterm infants may experience rapid clinical deterioration and require extracorporeal membrane oxygenation (ECMO) as a rescue therapy.ObjectiveTo describe the characteristics and clinical outcomes of neonates requiring ECMO for acute bronchiolitis over the past decade.MethodsAn observational, retrospective, single-center study conducted in a level IIIC neonatal unit. All neonates admitted between 2013 and 2022 who required ECMO for bronchiolitis-related respiratory failure were included. Demographic, clinical, and outcome variables were analyzed.ResultsSix patients were included: five (83%) were preterm, with a median gestational age of 28.6 weeks (IQR 27.1-29.6). Respiratory syncytial virus was isolated in four patients, rhinovirus in one and influenza A in one. At ECMO initiation, median age was 48.5 days (IQR 34-120), median postmenstrual age was 38 weeks (IQR 35-41.8), and median weight was 2490 g (IQR 1800-2900). The median duration of ECMO was 14 days (IQR 9-24). Two patients (33%) died, both preterm with RSV infection. All survivors were followed up by pediatric pulmonologists and neurologists. Two required home oxygen, and three showed neurodevelopmental disorders.ConclusionIn our cohort, the two non-survivors were preterm, RSV positive, and required prolonged ECMO support. Among survivors, respiratory and neurodevelopmental complications were common, underscoring the need for structured long-term follow-up. Neurodevelopmental impairment was the most frequent sequela observed.