Listeria monocytogenes and Severe Newborn Respiratory Failure Supported With Extracorporeal Membrane Oxygenation

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Abstract
Objective: To determine the efficacy of extracorporeal membrane oxygenation (ECMO) in newborn infants with early-onset Listeria monocytogenes infection, necrotizing pneumonia, and severe respiratory failure. Design: Patient series. Setting: ECMO referral centers. Participants: The Extracorporeal Life Support Organization Registry database of patients supported with ECMO between 1975 and 1991. Intervention: ECMO. Measurements and Results: Nine neonates were identified who were supported with ECMO for severe respiratory failure associated with L monocytogenes infection. Microbiologic studies demonstrated L monocytogenes organisms in the blood of all infants, and pneumonia was diagnosed by roentgenogram and/or isolation of L monocytogenes organisms in tracheobronchial secretions. All infants experienced progressive respiratory deterioration by age 36 hours and were placed on venoarterial bypass by 96 hours, having met institution-based criteria predictive of 80% to 90% mortality. The duration of ECMO for patients with Listeria infection (median, 210 hours; range, 137 to 454 hours) was prolonged compared with the duration of ECMO for neonates in all other registry diagnostic categories (median, 114 hours; range, 1 to 744 hours; N=5146, P=.035). Six of the nine infants recovered completely. Conclusions: These data suggest that ECMO is efficacious in patients with severe respiratory failure secondary to Listeria sepsis. Prolonged time on bypass should be expected when Listeria sepsis is associated with severe necrotizing pneumonia. (Arch Pediatr Adolesc Med. 1994;148:513-517)