Low Birth Weight Infants Research Articles

Development of a realistic simulation program for the treatment of extremely low birth weight infants

Premature babies are extremely vulnerable. The care they receive after birth is critical to their survival. Professor Shigeo Iijima, Hamamatsu University School of Medicine, Japan, is a specialist neonatologist devoted to improving the care that premature babies receive. As short‐ and long term prognosis are affected by the resuscitation procedures at birth and the management of sudden deterioration in extremely low birth weight (ELBW) infants, accurate situational assessment, rapid decision-making and prompt and reliable skills for interventions during birth and in emergencies are crucial. Iijima believes that outcomes can be improved through the development of a robust standard neonatal resuscitation program tailored to ELBW infants. There is no standardised national training programme for ELBW neonates in Japan and the standard neonatal resuscitation programme currently in place is designed for term infants. Iijima wishes to develop a programme that simulates real-life scenarios of resuscitation at birth to train young doctors responsible for ELBW babies. This will include scenario-based training for emergencies that may occur during the NICU stays of ELBW infants. The goal is to provide invaluable tools to develop the skills needed to assess each situation and determine and carry out a suitable management strategy. The scenario-based training utilises real equipment such as cardiorespiratory monitors and arterial oxygen saturation (SpO2) monitors and clinically realistic training scenarios.

Human milk and bronchopulmonary dysplasia have a dose-dependent effect: a cohort study

BackgroundHuman milk (HM) is considered a potential protective factor against bronchopulmonary dysplasia (BPD), but the specific volume needed for its protective effect in mixed feeding is unclear. This study aimed...

Anemia and retinopathy of prematurity: A narrative review

ABSTRACTRetinopathy of prematurity (ROP) and anemia are often comorbid in preterm and low birth weight infants in the United States. However, the relationship between ROP and anemia in infants is unclear across prospective and retrospective studies due to confounding from other comorbidities of prematurity and variable study designs. Molecular mechanisms that may underlie this association include tissue hypoxia, oxidative stress, inflammation, and the timing of onset of anemia relative to the phase of ROP. Furthermore, maternal or neonatal disruptions in iron homeostasis, leading to either iron deficiency or accumulation, have been associated with ROP. Further studies, including randomized clinical trials, are needed to better elucidate the association between ROP and anemia, as well as the impact of the timing of the onset of anemia.

470 Parental visitation and neonatal outcomes in very low birth weight infants in the neonatal intensive care unit

470 Parental visitation and neonatal outcomes in very low birth weight infants in the neonatal intensive care unit

460 Neonatal acute kidney injury and neurodevelopmental impairment: investigating associations in very low birthweight infants

460 Neonatal acute kidney injury and neurodevelopmental impairment: investigating associations in very low birthweight infants

628 Insights into pneumothorax in very low birth weight (VLBW) infants

628 Insights into pneumothorax in very low birth weight (VLBW) infants

695 Comparing neurodevelopmental outcomes in premature very low birth weight infants born to mothers with and without diabetes

695 Comparing neurodevelopmental outcomes in premature very low birth weight infants born to mothers with and without diabetes

The effects of early enteral feeding, fortification, and rapid feeding advancement in extremely low birth weight infants.

Preterm infants are at risk for necrotizing enterocolitis (NEC) and sepsis. Optimal strategies of preterm feeding to achieve full enteral feeding early with minimal duration of central lines without increasing the risk of NEC remain uncertain. We aimed to evaluate if new enteral feeding strategies reflecting early initiation, fortification, and more rapid advancement is beneficial without increasing the risk of NEC. We performed a retrospective cohort study including 122 infants born with birth weight<1000g during Period 1 (old feeding protocol, n=61) and Period 2 (new feeding protocol, n=61) to compare the incidence of NEC, late-onset sepsis, the duration of central line, and the growth outcomes before and after the implementation of feeding strategies to reflect early initiation of feeding within 12h of life, early fortification at 60mL/kg/day, and more rapid feeding advancement up to 30mL/kg/day. Median time to reach full enteral feeds was decreased from 9 to 6days (p<0.001). The duration of central venous catheters was also improved from median 7 to 5days (p<0.001). The incidence of NEC was not different (11.5% in Period 1 vs. 8.2% in Period 2, p=0.54). 14 infants (23%) had late-onset sepsis in Period 1 vs. 8 infants (13.1%) in Period 2 (p=0.16). The growth outcome was comparable between the two periods (p=0.47). Earlier initiation of enteral feeding and fortification, and more rapid advancement were safely introduced with significantly shorter duration of central lines without increasing the incidence of NEC.

P-2337. Contemporary Epidemiology of Infant Mortality Attributable to Cytomegalovirus Infection in the United States, 2007-2021

Abstract Background Cytomegalovirus (CMV) infections are common in infants in the United States (US) but infant mortality due to CMV has been poorly studied and it is unknown if there have been changes in CMV infant mortality rate (CMV-IMR) over time. We described the characteristics of a contemporary national cohort of infants who died from CMV and whether the CMV-IMR changed from 2007 to 2021.Table 1.Characteristics of the national cohort of infants who died from CMV infections and their corresponding CMV-IMR, 2007-2009. Methods This was a retrospective serial cross-sectional analysis of the CDC's linked birth and infant death records from 2007-2021. We used ICD-10 codes to identify infants &amp;lt; 1 year of age who had CMV infection listed as the underlying cause of death.The crude CMV-IMR was calculated per 1,000,000 live births and further stratified by gender, birth weight, gestational age, age at death, race, and census region. The Mann-Whitney U test was used to compare two groups and P &amp;lt; 0 .05 defined statistical significance. Trends were evaluated with Joinpoint regressionand expressed as average annual percentage change (AAPC) with 95% confidence intervals (CI). Results Out of 59 million live births, 406 infant deaths were attributed to CMV infections (crude CMV-IMR of 6.9 per 1,000,000). This resulted in at least 30,044 years of potential life lost. Notable characteristics of the study cohort were (Table 1): 78.8% low birth weight, 72.4% preterm, 63.8% of the mothers had at least high school education, 14 states had 64% of the CMV deaths, and 45.3% died within 28 days of birth. The CMV-MR was higher in low birth weight and preterm infants and was inversely related to gestational age (Table 1). The CMV-IMR varied by race [highest in Non-Hispanic Black (9.9)], censusregion [highest in the Midwest (8.5)], and by state [4.3 in Illinoisand 12.3 in Alabama]. There was a non-significant decrease in the CMV-IMR from 9.3 to 4.1 (AAPC -2.9%; CI: -6.7 – 1.0%.)which was insignificant at 95%CI. Conclusion The ubiquitous nature of CMV and the higher mortality in preterm and low birth weight infants should prompt serious consideration for early and universal CMV screening in these infants. The racial disparities in CMV-IMR suggest differential public health action toward awareness, prevention, and treatment of CMV. Addressing these disparities must be a top priority. Disclosures All Authors: No reported disclosures

Improved growth velocity using a new liquid human milk fortifier in Very Low Birth Weight infants: a multicenter, retrospective study.

To compare growth outcomes and tolerance among very low birth weight (VLBW) infants receiving a new, liquid human milk fortifier (LHMF-NEW) or a human milk fortifier-acidified liquid (HMF-AL). Retrospective, multicenter study of 515 VLBW infants in three regional NICUs. The primary objective was to compare growth velocity (g/kg/day) during fortification between groups by repeated measures regression. Secondary outcomes of interest were feeding tolerance and the incidence of late onset sepsis, necrotizing enterocolitis and metabolic acidosis. Student's t, ANOVA, Wilcoxon, and Kruskal-Wallis tests were used for numeric variables, or, chi-squared and Fisher's exact test for categorical variables. No demographic differences were identified between the groups (HMF-AL, n= 242; LHMF-NEW, n= 273). Growth velocity during fortification was significantly higher in the group receiving LHMF-NEW, despite relatively similar total fluid, calorie or protein intake (p=. ). Feeding intolerance was comparable between fortifiers. Necrotizing enterocolitis and late onset sepsis did not differ between groups and metabolic acidosis was diagnosed less frequently with the LHMF-NEW. Anthropometric measures at discharge and length of stay were comparable. Infants receiving human milk fortified with the LHMF-NEW had faster growth velocity during fortification, similar tolerance and less metabolic acidosis compared with an earlier cohort of infants who received human milk fortified with a HMF-AL.

P-1164. Prevalence of invasive Candidiasis and antifungal resistance in neonates: a multicenter three-year retrospective analysis from two large Mexican NICUs

Abstract Background Candida infections are increasingly recognized as clinically relevant pathogens in NICUs, particularly among preterm and low birth-weight infants (LBWI). Due to the emergence of Fluconazole-resistant Candida spp, current treatment guidelines of neonatal invasive Candidiasis (IC) suggest Amphotericin B as first line therapy, leaving Fluconazole as an alternative agent. Microbiological surveillance focused on fungal etiologies in Mexican NICUs is scarce, which may lead to inappropriate antifungal use. Methods Retrospective multicenter study conducted in the NICUs of the two pediatric reference hospitals in NL, Mexico. Clinical and microbiological data of all newborns ≤28 days diagnosed with blood culture-proven invasive Candidiasis from 2021-2023 were collected. LBWIs were defined as newborns &amp;lt; 2500 g at birth, and very LBWI (VLBWI) as &amp;lt; 1500 g. Descriptive statistical analyses were performed to determine the frequency of Candida spp and frequency of antifungal resistance. Results During the studied period, 928 positive blood cultures were included. Only 38 blood cultures (4%) were positive for Candida spp. No outbreaks occurred during the studied period. Twenty one patients (75%) were preterm. Mean gestational age was 29 weeks. Most patients (55%) were VLBWI (Table 1). All episodes were classified as late-onset sepsis. The most common isolated species were C. albicans (45%), followed by C. glabrata (29%), and C. parapsilosis (16%). No Fluconazole resistance was observed (Table 2). Caspofungin resistance was found in 5 C. glabrata isolates and 1 C. albicans. No cases of endophthalmitis or endocarditis were documented. Conclusion We report a low prevalence of blood culture-proven neonatal IC (4%) in two large Mexican NICUs during the studied period. Most patients were LBWI. This is consistent with international data. C. albicans was the most common isolated species. Based on the local epidemiology in two large NICUs of NL Mx, Fluconazole may be considered as a first line antifungal agent instead of Amphotericin B. Local microbial epidemiology and antifungal susceptibility patterns should be considered for the empirical treatment. Disclosures All Authors: No reported disclosures

P-995. Increased Red Cell Distribution Width (RDW) is associated with culture positive sepsis and with increased need of escalation in respiratory support in very low birth weight infants more than seven days of life undergoing sepsis workup secondary to vitals instability in the form of multiple episodes of true apneas or bradycardia and desaturations associated with apnea

Abstract Background Apnea of prematurity is nearly universal among very low birth weight infants (VLBW). In VLBW infants, changes in clinical status usually occur due to sepsis or non-infectious causes and it is challenging to differentiate between the two. We as clinicians use irregularities in vital signs as an early warning sign of sepsis to facilitate early treatment and improve patient outcomes. Adults have used RDW as a marker of worsening respiratory status and mortality from acute respiratory distress syndrome (ARDS). In this study, we seek to investigate elevations in Red Cell Distribution Width (RDW) as markers for culture positive sepsis and need for escalation of respiratory support in VLBW neonates. Association between RDW values and positive cultures Methods We did a retrospective chart review using the Electronic Medical Records (EMR) of VLBW infants (&amp;lt; 1500g) admitted to the Neonatal Intensive Care Unit (NICU) of a community hospital over 3 years. We included all babies who had True apnea (apnea &amp;gt; 20 seconds) or apnea with bradycardia and desaturations, after day seven of life and had CBC tests sent and were being managed for presumed late onset sepsis secondary to this vital sign instability. Other demographic data was gathered and tabulated. The data was analyzed to check for association between increased red cell distribution width (RDW) and need for escalation of respiratory support. Escalation in respiratory support included an increased need of assisted ventilation to support breathing. We also looked at positive blood / urine cultures and RDW values. Association between RDW values and change in baseline respiratory support Results 50 babies matched our inclusion criteria. 31 babies had a positive blood /urine culture. 21 of the 31 had elevated RDW which was statistically significant at p&amp;lt; 0.05 (Table1), hence showing that positive culture late onset sepsis had elevated RDW. Also, we saw increased need for escalation in respiratory support amongst culture positive babies with an elevated RDW at p &amp;lt; 0.05 (Table 2). Conclusion We conclude from this, that elevations in RDW is a marker for VLBW babies needing escalation in respiratory support. Elevations were also seen in culture positive sepsis. More studies need to be done as most of the available data is in adults. We can look more associations in babies with RDS (respiratory distress syndrome) and predict respiratory distress and for early interventions and better outcomes. Disclosures All Authors: No reported disclosures

P-1185. Targeting and Universal Congenital Cytomegalovirus Screening in a Neonatal Intensive Care Unit

Abstract Background Congenital cytomegalovirus (cCMV) infection, confirmed by urine or saliva CMV PCR within 3 weeks of life, affects 0.5 % of live births in the United States. This number varies in different populations, and it is affected by socio-demographic characteristics. In Neonatal Intensive Care Units (NICUs), higher prevalence has been reported in preterm and low birth weight infants, but timing of screening remains a challenge without universal screening because only 10% of cCMV are symptomatic. Regardless of symptoms, infected infants are at increased risk of adverse outcomes such as hearing loss. Thus, we sought to determine the incidence and associated characteristics of cCMV infection using targeting and subsequently universal screening in our NICU population Methods From Feb 1, 2023 to Apr 30, 2024, infants who were admitted at Tampa General Hospital (TGH) NICU and had a CMV PCR testing performed during admission were followed prospectively. Before Feb 28, 2024, cCMV screening was performed only in infants who were symptomatic (IUGR, microcephaly, thrombocytopenia) or failed hearing screen. After that, all infants born preterm &amp;lt; 33 weeks gestational age (GA) and all infants with anticipated NICU stay &amp;gt; 3 weeks were screened for cCMV at admission. Characteristics such as GA, birth weight, and race and ethnicity are recorded in a RedCap database. Descriptive statistics were used Results A total of 715 infants were screened for CMV while hospitalized in the TGH NICU during the study period. Most of the infants (68.2%) were screened after failing newborn hearing screen and only four (0.6%) were screened because of their symptoms. The characteristics of the infants with positive and negative saliva or urine CMV PCR are described in Table 1. Only three (0.4%) infants tested positive for CMV and were confirmed to have cCMV. Two infants with cCMV infection were screened because they were symptomatic Conclusion At TGH NICU, the incidence of cCMV using targeting and universal screening was comparable with the U.S. general population and lower than reported in other NICUs. We plan to perform association when statistically feasible, and compare incidence of cCMV between the targeting and universal screening periods Disclosures Claudia M. Espinosa, MD, MSc, AstraZeneca: Grant/Research Support|Clinetics: Grant/Research Support|Enanta: Grant/Research Support|Gilead: Advisor/Consultant|Jansen &amp; Jansen: Advisor/Consultant|Kentucky Health Rural Association: Honoraria|Medimmune: Grant/Research Support|Melinta: Grant/Research Support|Merck: Grant/Research Support|Sanofi: Advisor/Consultant|Sanofi: Honoraria

P-183. Barriers and Facilitators to Identifying and Treating Neonatal Sepsis in Ethiopia

Abstract Background Neonatal sepsis is a major cause of death of children under the age of 5 years globally and in Ethiopia. The high mortality associated with neonatal sepsis is especially pronounced in low-birth weight infants (LBW). Antimicrobial resistance (AMR) further contributes to high mortality. Many hospitalized LBW newborns with sepsis are admitted to NICUs but mortality remains high, partly due to increasing AMR but also due to delayed identification and treatment. Thus, evaluating and describing the existing barriers to sepsis diagnosis and management is urgently needed. This may guide targeted innovations to predict, diagnose, and treat neonatal sepsis earlier and avert newborn deaths. Methods Utilizing structured chart review and focus groups we conducted a convergent mixed methods study evaluating facilitators and barriers to early identification and care of neonates admitted with sepsis to the neonatal intensive care unit at Tibebe Ghion Specialized Hospital in Bahir Dar, Ethiopia. Results 6 resident physicians and 6 nurses participated in 2 focus groups, and 142 charts were reviewed. Chart review revealed that infants with documented warning signs (such as fast breathing or failure to suck) begin an empiric course of ampicillin and gentamycin. Further diagnostic workup is often limited, and blood cultures are rarely performed. Qualitative interviews reenforced and expanded these results. Key barriers identified included limited physical resources (monitoring equipment, laboratory capacity, and imaging) and personnel barriers (limited staffing, low morale, and frequent staff transfer). Primary facilitators included understaffing, retention of experienced staff, and access to necessary equipment and diagnostics. Conclusion Even in a higher-level hospital in Ethiopia, neonatal sepsis is challenging to identify due in part to limited diagnostic capacity and understaffing. The absence of cultures and sensitivities and other diagnostics present barriers to early identification and targeted treatment. Future studies could focus on interventions to expand lab capacity and diagnostics, including point of care diagnostics for sepsis or AMR, capacity building of neonatal nursing, and expansion of access to low-cost vital sign monitoring. Disclosures All Authors: No reported disclosures

Effect of active-duty military service on neonatal birth outcomes: a systematic review

IntroductionIncreasing numbers of women serve in the armed forces in countries worldwide. Stress experienced during pregnancy is associated with adverse birth outcomes including preterm delivery (PTD) and low birth weight...

Chromium-free parenteral nutrition and its effects on chromium levels in very low birth weight infants.

as chromium (Cr) is known to contaminate components of parenteral nutrition (PN), Cr-free PN is recommended for preterm infants. Exposure to Cr by PN in preterm infants is scarcely investigated. to describe Cr levels in plasma (Crp) and urine (Cru) during the first month of life in premature newborns ≤ 1500 g of birthweight (BW) receiving PN, and to evaluate the impact on postnatal clinical parameters. a prospective observational study. Cr-free PN was administered at day 1 of life and continued until full enteral feeding with fortified breastmilk began. Crp levels at day 15 and 30 and Cru at day 30 of life were assessed according to demographic factors, biochemical markers and postnatal morbidity. 97 infants had a median gestational age (GA) of 29.9 weeks, and a median BW of 1205 g. Median Crp remained at 1.0 µg/L at 15 and 30 days (IQR 0.7-1.4 and 0.7-1.3, respectively). Premature babies < 26 weeks had a significantly higher Crp at one month than the remainder (p = 0.043) and higher Cr elimination in the urine (p = 0.026). Crp increased with prolonged PN (p < 0.001), even after adjusting for gestational age (p = 0.001). Laboratory parameters were not influenced by Crp or Cru, nor was morbidity. Crp increases with days of PN even when a trace mineral supplement without Cr is used, and the level reached persists during the first month of life with the introduction of Cr-supplemented breastmilk feeding. No relation to morbidity was observed.

Evaluation of Hospital Outcomes Among Very Low Birth Weight Babies in a Community-Level Medical College Hospital

Introduction: Very low birth weight (VLBW) babies are at increased risk from a wide range of hazards resulting from immaturity of structure and functions of many organs, which may cause death or permanent damage. Objective: The objective of this study was to evaluate immediate outcomes in VLBW babies. Materials and Methods: This hospital-based prospective cohort study was conducted in the Department of Paediatrics, Kumudini Women’s Medical College and Hospital, Mirzapur, Tangail from August 2008 to July 2009. At enrollment VLBW babies (birth weight &lt;1500 grams) were assessed for gestational age and weight. Patients were followed up daily till discharge or death. The outcome in terms of survival till discharge was recorded. Informed verbal consent from the caregiver was taken before enrolment. Results: A total of 60 VLBW neonates were enrolled in the study. Eight (13.3%) neonates had weights below 1000 grams and 52 (86.7%) had 1000-1499 grams. Five (8.3%) neonates had gestational age &lt;28 weeks, 44 (73.3%) were 29-32 weeks, and 11(18.3%) were 33-36 weeks. Maternal age, place, and mode of delivery were significant contributory factors. In the present study, 35(59%) of VLBW babies expired; 100% of babies died below 1000 grams. Neonatal mortality showed an inverse relationship with birth weight and gestational age. Conclusion: Proper antenatal care should be encouraged throughout the country to prevent the neonatal mortality associated with VLBW infants. Management of labor is important and facilities for the management of high-risk pregnancy should be made available widely. Immediate management of newborns after birth can prevent the worst hospital outcomes in our country. The Journal of Ad-din Women's Medical College; Vol. 12 (2), July 2024; p 21-25

Impact of Inhouse Human Milk Bank on Neonatal Mortality and Morbidities in VLBW Neonates in an Extramural Unit: An Observational Study

Introduction: Human Milk is considered the ideal nutrition for all babies especially in preterm and in low birth-weight babies. When mother’s milk is not available, the WHO recommends Pasteurised Donor Human Milk (PDHM) as the next best infant feeding alternative. Methodology: This observational study was conducted in a tertiary level NICU in India to assess the impact of Human Milk Bank (HMB) on mortality and morbidities in VLBW and ELBW neonates. The primary outcome was to compare the incidence of definite and advanced NEC and secondary outcomes were to assess death, exclusive breastfeeding at discharge, feed interruption and growth in both the groups. Pre-Human Milk bank and Post-human Milk Bank data were collected for a period of 24 months each. Results: The incidence of Definite and Advanced NEC was significantly lower in Post-HMB group (2;1.76%) than in Pre-HMB (10; 9.4%) (p=0.00). 43.4% of babies in Pre-HMB group and 19.5% babies in post-HMB group had NEC (Any stage); p=0.00. Neonatal deaths were higher in the Pre-HMB group 32 (30.2%) than in post-HMB group 22 (19.5%); (p=0.066). The exclusive breastfeeding rate was significantly higher in the post-HMB group 72.6% as compared to 30.2% in the pre-HMB group (p=0.00). Feed interruptions were significantly lower in the post-HMB group 29 (25.7%) as compared to Pre-HMB group 56 (52.8%) (p=0.00). Time to reach full feeds was significantly lower in the post-HMB group Median (IQR) 13 (7.25 – 25.75) days as compared to 10 (5 – 17) days (p=0.007). Time to regain birth weight was significantly lower in the post-HMB group (14.72 + 5.61) as compared to pre-HMB group (11.00 + 4.19) (p=0.00) Conclusion: Establishment of Human Milk bank can be a worthwhile quality improvement project that NICUs can launch as part of comprehensive plans to enhance preterm care.

The Association Between Perinatal Pharmacologic Treatments and Spontaneous Intestinal Perforation in Extremely Preterm Infants: A Propensity Score Matching Study

Background: The impact of perinatal pharmacologic agents on spontaneous intestinal perforation (SIP) in extremely low-birthweight (ELBW, &lt;1000 g) preterm infants remains inconclusive based on findings from retrospective cohort or case–control studies. This study aims to address this uncertainty by using propensity score matching (PSM) to reduce bias. Methods: We retrospectively reviewed ELBW infants in our unit between 2014 and 2023 to identify SIP cases. Confirmed through medical notes, surgical consultation, and author review, each SIP case was matched at a 1:3 ratio using propensity scores on factors including the gestational age (GA), birthweight, gender, and birth year. Pharmacologic agents commonly given antenatally and postnatally were analyzed. Only medications that were started 24 h before the onset of SIP or the corresponding age (PSM-controls) were included. Results: A total of 858 ELBW infants were reviewed, 28 SIP cases (GA 25.3 ± 2.1 weeks, BW 735 ± 167 g) were identified, and 84 PSM-controls were matched. The SIP cases received hydrocortisone (25% (7/28) vs. 9.5% (8/84), p = 0.037) and combined inotropic agents (17.9% (5/28) vs. 2.4% (2/84), p = 0.020) to a significantly greater extent. No differences were observed in the use of other medications. In logistic regression, the use of hydrocortisone and combined inotropes remained independent risks for SIP, with ORs (95% CIs) of 3.4 (1.1–10.9) and 2.1 (1.2–3.8), respectively. Conclusions: This first PSM-based study supported postnatal hydrocortisone and combined inotrope use as independent risks for SIP in ELBW infants. Clinicians should be aware of these risks and remain vigilant for SIP when administering hydrocortisone and inotropes.

How low should we go? Outcomes of ECMO in neonates with low gestational age or birth weight.

Initial recommendations for ECMO had relative contraindications for low birth weight (BW) or low gestational age (GA) babies. However, more recent literature has demonstrated improved and acceptable outcomes of ECMO in smaller neonates. The purpose of this study was to understand both utilization and survival in patients with lower GA and BW. All neonates captured in the Extracorporeal Life Support Organization (ELSO) registry who underwent a single ECMO run from 2009 to 2019 were included. The primary outcome measure was mortality and the secondary outcome measure was major adverse outcomes, defined as a composite outcome variable any severe ECMO complications. Univariate and multivariable statistical tests were performed to estimate the association between GA and BW with both outcome variables. A total of 14,167 cases met inclusion criteria. Univariate analysis noted that birth weight, gestational age, ECMO mode, pulmonary support type, pH and ventilator settings were highly significant predictors of survival. Multivariable assessment noted significant linear relationship of mortality rates with increasing GA and BW (p < 0.001, OR = 0.82 GA, 0.51 BW). The highest ECMO-related mortality was observed in neonates with GA 30-31weeks and BW 1.5-2.0kg, with a 70-75% in-hospital mortality rate. Decreasing GA and BW were strongly correlated with increasing odds of mortality and/or ECMO-related complications. However, even in low GA or BW neonates, survival may be possible in up to a quarter of patients put on ECMO.