INTRODUCTION The incidence of thrombocytopenia in neonates receiving extracorporeal membrane oxygenation (ECMO) with and without concurrent continuous renal replacement therapy (CRRT) and associated complications have not been well described. The primary aims of the current study were to (1) characterize thrombocytopenia in neonates receiving ECMO (including those treated concurrently with CRRT) and (2) evaluate risk factors (including CRRT utilization) associated with severe thrombocytopenia. In a planned exploratory secondary aim, we explored the association of severe thrombocytopenia with outcomes in neonates receiving ECMO. METHODS We conducted a retrospective single-center chart review of neonates who received ECMO 07/01/14-03/01/20 and evaluated associations between CRRT, severe thrombocytopenia (platelet count <50,000/mm3), and outcomes (ECMO duration, length of stay, and survival). RESULTS Fifty-two neonates received ECMO; 35 (67%) received concurrent CRRT. Severe thrombocytopenia occurred in 27 (52%) neonates overall and in 21 (60%) neonates who received concurrent CRRT. Underlying diagnosis, ECMO mode, care unit, and moderate/severe hemolysis differed between those who did and did not receive CRRT. CRRT receivers experienced shorter hospital stays than CRRT non-receivers, but ECMO duration, length of intensive care unit (ICU) stay, and survival did not differ between groups. CRRT receipt was associated with severe thrombocytopenia. Exploratory classification and regression tree (CART) analysis suggests CRRT use, birthweight, and ICU location are all predictors of interest for severe thrombocytopenia. CONCLUSIONS In our cohort, CRRT use during ECMO was associated with severe thrombocytopenia, and patients who received ECMO with CRRT experienced shorter hospital stays than those who did not receive CRRT. Exploratory CART analysis suggests CRRT use, birthweight, and ICU location are all predictors for severe thrombocytopenia and warrant further investigations in larger studies.

中文翻译：

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新生儿体外膜氧合：连续肾脏替代治疗、血小板减少症和结果之间的关联。


引言 接受体外膜肺氧合 (ECMO) 并同时进行或不进行连续肾脏替代治疗 (CRRT) 的新生儿血小板减少症的发生率以及相关并发症尚未得到充分描述。本研究的主要目的是（1）描述接受 ECMO 的新生儿（包括同时接受 CRRT 治疗的新生儿）的血小板减少症特征，以及（2）评估与严重血小板减少症相关的危险因素（包括 CRRT 的利用）。在计划中的探索性次要目标中，我们探讨了严重血小板减少症与接受 ECMO 的新生儿结局之间的关系。方法 我们对 07/01/14-03/01/20 接受 ECMO 的新生儿进行了回顾性单中心图表审查，并评估了 CRRT、严重血小板减少症（血小板计数 <50,000/mm3）和结局（ECMO 持续时间、长度）之间的关联停留和生存）。结果 52 名新生儿接受了 ECMO； 35 人 (67%) 接受了同时 CRRT。总共有 27 名 (52%) 新生儿发生严重血小板减少症，其中 21 名 (60%) 接受同时 CRRT 的新生儿发生严重血小板减少症。接受和未接受 CRRT 的患者的基础诊断、ECMO 模式、监护病房和中度/重度溶血有所不同。 CRRT 接受者的住院时间比非 CRRT 接受者的住院时间短，但 ECMO 持续时间、重症监护病房 (ICU) 住院时间和生存率在各组之间没有差异。 CRRT 接受与严重血小板减少症相关。探索性分类和回归树 (CART) 分析表明 CRRT 的使用、出生体重和 ICU 位置都是严重血小板减少症的预测因素。 结论 在我们的队列中，ECMO 期间使用 CRRT 与严重血小板减少症相关，接受 ECMO 和 CRRT 的患者比未接受 CRRT 的患者住院时间更短。探索性 CART 分析表明 CRRT 的使用、出生体重和 ICU 位置都是严重血小板减少症的预测因素，值得在更大规模的研究中进行进一步研究。