(301) Neonatal Extracorporeal Membrane Oxygenation: Epidemiology by Social Drivers of Health

Tuesday, January 23, 2024

11:15 AM – 12:15 PM MT

Location: Connections Central - RST 07

First Author(s)

Swati Chandhoke

Pediatric Critical Care Medicine Fellow
Children's Healthcare of Atlanta - Egleston Hospital
Atlanta

Co-Author(s)

RD

Robert DiGeronimo, MD

Professor of Pediatrics, Division of Neonatology
University of Washington School of Medicine, Seattle Children’s Hospital, Seattle WA, United States
PL

Philip Levy, MD

Assistant Professor of Pediatrics
Boston Children's Hospital, United States
SH

Shannon E. G. Hamrick, MD

Associate Professor of Pediatrics Divisions of Neonatology and Cardiology
Emory University and Children’s Healthcare of Atlanta, United States
IZ

Isabella Zaniletti, Ph.D

Statistician
Children's Hospitals Neonatal Consortium, IZ Statistics LLC, United States
KM

Karna Murthy, MD

Professor of Pediatrics
Northwestern University Feinberg School of Medicine, United States
MP

Michael Padula, MD, MBI, FAAP

Medical Director of Informatics and an Attending Neonatologist
Children's Hospital of Philadelphia, United States
TG

Theresa Grover, MD, MAS

Professor
University of Colorado School of Medicine, Children's Hospital Colorado, United States
Katie Moynihan, MD, FCICM, FRACP (she/her/hers)

Cardiac Intensivist
Boston Children's Hospital
Boston, Massachusetts

Introduction: SDoH impact numerous neonatal and pediatric outcome domains. ECMO is a life-sustaining therapy susceptible to SDoH influences. We studied neonates supported on ECMO leveraging the Children’s Hospitals Neonatal Consortium Database of 36 US level 4 NICUs.

Methods: Neonates >34 weeks gestational age (GA) and birth weight >1.8kg supported on ECMO from 2010-2021 with a maternal zip code and race were identified. We examined clinical characteristics, outcomes, and SDoH including Child Opportunity Index (COI) quintiles, maternal race (non-Hispanic white, non-Hispanic Black, Hispanic, Asian, and other), payer, and travel distance. Univariate analyses identified associations with the primary outcome of NICU mortality. Associations between SDoH and NICU mortality were adjusted for diagnoses.

Results: Of 2254 neonates on ECMO (23% venovenous [VV]), 32% were supported for congenital diaphragmatic hernia (CDH), 27% for meconium aspiration syndrome (MAS), 13% for cardiac, and 28% for other diagnoses. Overall, 29% of neonates were in the very low COI quintile (vs 14% very high), 55% had public payers, and races were 51% White, 25% Black, and 17% Hispanic. Small for GA and MAS were more common in low COI (versus high) and Black races (versus white). White and Hispanic races had more preterm births, while conditions such as preeclampsia were common in underrepresented races. NICU mortality was 31%, with 42% discharged home. The median NICU length of stay (LOS) was 32 days [IQR 17,61] and ECMO duration was 7 [4,12]. CDH and cardiac patients had greater mortality (vs MAS, hazard ratio [HR] 3.8 [2.8,5.0] and 2.8 [2.0,4.0]) as did preterm birth, while VV cannulation was protective (HR 0.6 [95%CI 0.4,0.7]). We found no association between COI or travel distance with mortality. Higher mortality was seen in private (HR 1.3 [1.1, 1.5]) and self-pay (HR 2.8 [1.7, 4.4]) patients vs public. Black race was associated with lower mortality (HR 0.8 [0.7, 0.9]) vs white but not when adjusted for diagnosis. Run duration and LOS were similar across SDoH.

Conclusions: We identified different epidemiological characteristics among neonates supported on ECMO according to SDoH. Relationships between social drivers, clinical variables, health access, and outcomes in the neonatal ECMO population are complex, deserving of future study.