ECMO in Neonatal Respiratory Failure

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Questions and Answers

What is the primary indication for Extracorporeal membrane oxygenation (ECMO) in neonates?

Congenital heart disease

Neonatal respiratory failure (correct)

Meconium aspiration

Congenital diaphragmatic hernia

What is the effect of ECMO on protein catabolism in neonates?

It increases protein catabolism (correct)

It has no effect on protein catabolism

It stops protein catabolism

It slows down protein catabolism

What is the grade of evidence for initiating nutrition support expeditiously in neonates treated with ECMO?

D (correct)

What is the potential loss of lean body mass in neonates during a 7-day course of ECMO?

15% Signup and view all the answers

Why is optimal weight gain difficult to achieve in neonates treated with ECMO?

Due to all of the above Signup and view all the answers

What is the purpose of this Clinical Guideline?

To address the nutrition support of neonatal patients treated with ECMO Signup and view all the answers

What is the consequence of not providing optimal nutrition support to neonates treated with ECMO?

Protracted catabolic stress Signup and view all the answers

What is the benefit of ECMO therapy in pediatric and adult applications?

Improved mortality Signup and view all the answers

Why is PN generally used as the initial nutrition support in patients on ECMO?

To rapidly attain metabolic stabilization and adequate nutrition Signup and view all the answers

What is the benefit of using EN in critically ill patients when gastrointestinal function is normal and the patient is clinically stable?

Reduced risk of gastrointestinal complications Signup and view all the answers

What did the large, retrospective study of neonatal and pediatric ICU patients reveal?

A lower rate of complications in patients fed continuous post-pyloric enteral feedings Signup and view all the answers

What did the prospective cohort study of neonatal and pediatric patients in shock reveal?

The majority of patients could tolerate enteral feeding Signup and view all the answers

What is the usual approach to nutrition support in most neonates treated with ECMO?

PN initiated within 24 hours Signup and view all the answers

What is the consequence of slow tolerance to EN in neonates?

A 3.6-fold longer length of hospital stay Signup and view all the answers

What is the concern regarding enteral feeding in patients on ECMO?

Theoretical risk of increasing intestinal ischemia or bacterial translocation Signup and view all the answers

What was the outcome of the retrospective study comparing EN to PN in pediatric ECMO patients?

EN was well-tolerated and without complication Signup and view all the answers

What is the nutritional issue that neonates on ECMO support may experience beyond discharge?

All of the above Signup and view all the answers

What is the recommended protein intake for neonates on ECMO support?

3 g/kg/d Signup and view all the answers

What is the goal of protein provision in neonates on ECMO support?

To promote nitrogen balance and optimize growth Signup and view all the answers

What is the consequence of negative protein balance in neonates on ECMO support?

All of the above Signup and view all the answers

What is the recommended energy intake for neonates on ECMO support?

100-120 kcal/kg/d Signup and view all the answers

Why is excess protein administration not recommended in neonates on ECMO support?

It can cause toxicity, particularly in patients with marginal renal or hepatic function Signup and view all the answers

What is the consequence of excess calorie administration in neonates on ECMO support?

Increased carbon dioxide production with exacerbation of respiratory failure Signup and view all the answers

When should enteral feedings be initiated in neonates on ECMO support?

When the patient has clinically stabilized Signup and view all the answers

What is the effect of insulin infusion on protein balance in neonates on ECMO support?

It decreases protein catabolism Signup and view all the answers

What is the significance of measuring nitrogen balance in neonates on ECMO support?

It measures nitrogen balance, which is a surrogate for protein balance Signup and view all the answers

Study Notes

Extracorporeal Membrane Oxygenation (ECMO)

ECMO is a modified heart-lung machine used in cases of profound cardiorespiratory failure.
It has been used successfully in pediatric and adult applications, with the most frequent indication being neonatal respiratory failure.
Common conditions that require ECMO include persistent pulmonary hypertension, congenital diaphragmatic hernia, congenital heart disease, and meconium aspiration.

Nutritional and Metabolic Burden in ECMO Patients

ECMO patients have high rates of protein catabolism, with neonates demonstrating some of the highest rates reported.
ECMO does not provide a "metabolic rest," and nutritional support is crucial to enhance growth and development.

Nutrition Support in ECMO Patients

Nutrition support should be initiated expeditiously in neonates treated with ECMO, with a goal of 100-120 kcal/kg/d and protein up to 3 g/kg/d.
Neonates on ECMO have protein requirements of up to 3 g/kg/d, with a goal of promoting nitrogen balance and optimizing growth and development.
Energy requirements in neonates treated with ECMO are equivalent to healthy subjects, with a goal of 100-120 kcal/kg/d.

Enteral Feedings in ECMO Patients

Enteral feedings should be initiated when the patient on ECMO has clinically stabilized, with caution advised prior to starting EN in patients who have not yet stabilized.
Enteral nutrition (EN) is generally well-tolerated in ECMO patients, despite intestinal dysfunction, and may be beneficial when provided in addition to PN support.
Neonates who have slow tolerance to EN have a longer length of hospital stay than those who are feeding optimally.

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Description

This quiz covers the use of Extracorporeal Membrane Oxygenation (ECMO) in neonatal respiratory failure, including its indications, benefits, and applications in pediatric and adult settings.