{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T16:26:35Z","timestamp":1776702395885,"version":"3.51.2"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Underweight and obesity represent opposite ends of the nutritional risk spectrum that negatively affect children\u2019s health worldwide. Both conditions have been associated with increased mortality in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To investigate the association of underweight and obesity status with pediatric ECMO outcomes using body mass index (BMI)\n z<\/jats:italic>\n scores.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort analysis used data from the Extracorporeal Life Support Organization (ELSO) database from January 1, 2019, to December 31, 2023. Participants included all pediatric patients from international ECMO centers aged 29 days to 18 years who received ECMO support during the study period. Data were analyzed from July 1, 2024 to June 30, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n BMI or weight for length.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Survival to hospital discharge.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 8885 children undergoing their first ECMO run during the study period were included. The median age was 1.9 years (IQR, 0.4-10.7 years), the median weight was 11 kg (IQR, 6-36 kg), and 4773 patients (53.7%) were male. Among the cohort, 6443 patients (72.5%) had a normal weight (\n z<\/jats:italic>\n scores \u22122 to 2), 1458 (16.4%) had underweight (\n z<\/jats:italic>\n score &amp;lt;\u20132), and 984 (11.1%) had obesity (\n z<\/jats:italic>\n score &amp;gt;2). Overall hospital survival occurred in 5453 patients (61.2%) but was significantly lower in patients with underweight (849 [58.2%]) and obesity (565 [57.4%]) compared with normal weight (4020 [62.4%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). In multivariable logistic regression, having underweight (odds ratio [OR], 1.34; 95% CI, 1.09-1.66;\n P<\/jats:italic>\n \u2009=\u2009.005) and obesity (OR, 1.25; 95% CI, 1.00-1.56;\n P<\/jats:italic>\n \u2009=\u2009.04) were associated with increased hospital mortality. This pattern persisted across subgroup analyses based on age and diagnosis leading to ECMO cannulation. Severe obesity (BMI\n z<\/jats:italic>\n score &amp;gt;3) was not associated with mortality.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of children receiving ECMO, 1 in 4 had an abnormal BMI, which was associated with increased hospital mortality. Prospective studies are warranted to further elucidate and define the association of nutritional status and clinical outcomes in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.6162","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T15:30:25Z","timestamp":1776699025000},"page":"e266162","source":"Crossref","is-referenced-by-count":0,"title":["Body Mass Index and Survival in Children Receiving Extracorporeal Membrane Oxygenation"],"prefix":"10.1001","volume":"9","author":[{"given":"Pilar","family":"Anton-Martin","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Anesthesiology and Critical Care Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Baxelbaum","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Health Informatics, Data Science and Biostatistics Division, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilpa","family":"Vellore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology, University of California, San Diego School of Medicine\/Rady Children\u2019s Hospital, San Diego"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"O\u2019Neil","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Air Force, Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas"},{"name":"Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinai","family":"Modem","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Cooks Children\u2019s Hospital, Fort Worth, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer","family":"Thadani","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine and Pediatric Nephrology, Baylor College of Medicine, Texas Children\u2019s Hospital, Houston"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"issue":"5","key":"zoi260216r2","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.3945\/ajcn.2010.29786","article-title":"Global prevalence and trends of overweight and obesity among preschool children.","volume":"92","author":"de Onis","year":"2010","journal-title":"Am J Clin Nutr"},{"issue":"4","key":"zoi260216r3","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1177\/0148607113479972","article-title":"Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions.","volume":"37","author":"Mehta","year":"2013","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"6","key":"zoi260216r4","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1111\/joim.13547","article-title":"Pediatric obesity\u2014long-term consequences and effect of weight loss.","volume":"292","author":"Marcus","year":"2022","journal-title":"J Intern Med"},{"key":"zoi260216r5","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.769401","article-title":"Is undernutrition associated with deterioration of outcomes in the pediatric intensive care unit (PICU): systematic and meta-analysis review.","volume":"10","author":"Albadi","year":"2022","journal-title":"Front Pediatr"},{"issue":"5","key":"zoi260216r6","doi-asserted-by":"publisher","first-page":"2772","DOI":"10.1016\/j.clnu.2021.04.010","article-title":"Association between admission body mass index and outcomes in critically ill children: a systematic review and meta-analysis.","volume":"40","author":"Toh","year":"2021","journal-title":"Clin Nutr"},{"key":"zoi260216r7","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1421155","article-title":"The association between nutritional status measured by body mass index and outcomes in the pediatric intensive care unit.","volume":"12","author":"Pournasiri","year":"2024","journal-title":"Front Pediatr"},{"issue":"3","key":"zoi260216r8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-2035","article-title":"Obesity and mortality risk in critically ill children.","volume":"137","author":"Ross","year":"2016","journal-title":"Pediatrics"},{"issue":"3","key":"zoi260216r9","doi-asserted-by":"publisher","first-page":"e481","DOI":"10.1542\/peds.2009-1324","article-title":"Childhood obesity and survival after in-hospital pediatric cardiopulmonary resuscitation.","volume":"125","author":"Srinivasan","year":"2010","journal-title":"Pediatrics"},{"issue":"1","key":"zoi260216r11","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1177\/0148607116673185","article-title":"Underweight status is an independent predictor of in-hospital mortality in pediatric patients on extracorporeal membrane oxygenation.","volume":"42","author":"Anton-Martin","year":"2018","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"1","key":"zoi260216r12","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1097\/MPG.0000000000003317","article-title":"Early enteral nutrition and gastrointestinal complications in pediatric patients on extracorporeal membrane oxygenation.","volume":"74","author":"P\u00e9rez","year":"2022","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"zoi260216r13","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.clnesp.2018.05.005","article-title":"Nutritional practices and adequacy in children supported on extracorporeal membrane oxygenation.","volume":"26","author":"Ong","year":"2018","journal-title":"Clin Nutr ESPEN"},{"issue":"8","key":"zoi260216r15","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1097\/CCM.0000000000001713","article-title":"Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU.","volume":"44","author":"Bechard","year":"2016","journal-title":"Crit Care Med"},{"issue":"1","key":"zoi260216r16","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1177\/0884533614557642","article-title":"Consensus statement of the Academy of Nutrition and Dietetics\/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition).","volume":"30","author":"Becker","year":"2015","journal-title":"Nutr Clin Pract"},{"issue":"3","key":"zoi260216r18","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/S0022-3476(05)81804-9","article-title":"Mortality and morbidity rates among lower birth weight infants (2000 to 2500 grams) treated with extracorporeal membrane oxygenation.","volume":"121","author":"Revenis","year":"1992","journal-title":"J Pediatr"},{"issue":"6","key":"zoi260216r19","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/j.jpedsurg.2004.02.012","article-title":"How low can you go? effectiveness and safety of extracorporeal membrane oxygenation in low-birth-weight neonates.","volume":"39","author":"Rozmiarek","year":"2004","journal-title":"J Pediatr Surg"},{"issue":"12","key":"zoi260216r20","doi-asserted-by":"publisher","first-page":"2018","DOI":"10.1016\/j.jpedsurg.2017.08.037","article-title":"Cannulating the contraindicated: effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation.","volume":"52","author":"Delaplain","year":"2017","journal-title":"J Pediatr Surg"},{"issue":"2","key":"zoi260216r21","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1055\/s-0036-1584681","article-title":"Childhood obesity and extracorporeal membrane oxygenation: special considerations for successful outcomes.","volume":"6","author":"Iyengar","year":"2017","journal-title":"J Pediatr Intensive Care"},{"issue":"4","key":"zoi260216r22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0176143","article-title":"Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation.","volume":"12","author":"Gil","year":"2017","journal-title":"PLoS One"},{"issue":"7","key":"zoi260216r23","doi-asserted-by":"publisher","first-page":"2202","DOI":"10.3390\/jcm14072202","article-title":"Impact of body mass index on stroke in extracorporeal cardiopulmonary resuscitation: data from the Extracorporeal Life Support Organization Registry.","volume":"14","author":"Kang","year":"2025","journal-title":"J Clin Med"},{"key":"zoi260216r24","doi-asserted-by":"publisher","first-page":"2376","DOI":"10.1053\/j.jvca.2021.11.012","article-title":"Effect of body mass index on the clinical outcomes of adult patients treated with venoarterial ECMO for cardiogenic shock.","volume":"36","author":"Girard","year":"2022","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"zoi260216r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2024.10.019","article-title":"Does obesity matter in patients receiving venoarterial extracorporeal membrane oxygenation? the U-shaped relationship between body mass index and mortality after extracorporeal cardiopulmonary resuscitation.","volume":"178","author":"Pai","year":"2025","journal-title":"Surgery"},{"issue":"4","key":"zoi260216r26","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1093\/ejcts\/ezab165","article-title":"Obesity is not a contraindication to veno-arterial extracorporeal life support.","volume":"60","author":"Salna","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"issue":"12","key":"zoi260216r27","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1097\/MAT.0000000000001507","article-title":"Complications of peripheral cannulation site in obese patients on adult extracorporeal membrane oxygenation.","volume":"67","author":"Alvarez","year":"2021","journal-title":"ASAIO J"},{"issue":"1","key":"zoi260216r28","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.athoracsur.2023.03.025","article-title":"The relation between obesity and mortality in postcardiotomy venoarterial membrane oxygenation.","volume":"116","author":"Heuts","year":"2023","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"zoi260216r29","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s00134-022-06926-4","article-title":"Impact of BMI on outcomes in respiratory ECMO: an ELSO registry study.","volume":"49","author":"Peetermans","year":"2023","journal-title":"Intensive Care Med"},{"key":"zoi260216r30","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jhin.2023.08.005","article-title":"Association of body mass index and bloodstream infections in patients on extracorporeal membrane oxygenation: a single-centre, retrospective, cohort study.","volume":"140","author":"Lee","year":"2023","journal-title":"J Hosp Infect"},{"issue":"6","key":"zoi260216r31","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1164\/rccm.202212-2293OC","article-title":"Mortality in patients with obesity and acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: the Multicenter ECMObesity Study.","volume":"208","author":"Rudym","year":"2023","journal-title":"Am J Respir Crit Care Med"},{"key":"zoi260216r32","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.jcrc.2018.08.003","article-title":"Obesity survival paradox in pneumonia supported with extracorporeal membrane oxygenation: analysis of the national registry.","volume":"48","author":"Cho","year":"2018","journal-title":"J Crit Care"},{"issue":"4","key":"zoi260216r33","doi-asserted-by":"publisher","first-page":"474","DOI":"10.4187\/respcare.11565","article-title":"Obesity and extracorporeal membrane oxygenation.","volume":"69","author":"Coccola","year":"2024","journal-title":"Respir Care"},{"issue":"6","key":"zoi260216r34","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1164\/rccm.202307-1261ED","article-title":"The obesity paradox in patients in need of extracorporeal membrane oxygenation.","volume":"208","author":"Pickkers","year":"2023","journal-title":"Am J Respir Crit Care Med"},{"issue":"6","key":"zoi260216r35","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1097\/SHK.0000000000001809","article-title":"Survival and outcomes after cardiac arrest with VA-ECMO rescue therapy.","volume":"56","author":"Schurr","year":"2021","journal-title":"Shock"},{"issue":"3","key":"zoi260216r36","doi-asserted-by":"publisher","first-page":"e567","DOI":"10.1097\/CCM.0000000000006547","article-title":"Obesity is associated with increased mortality in patients undergoing venoarterial extracorporeal membrane oxygenation.","volume":"53","author":"McCloskey","year":"2025","journal-title":"Crit Care Med"},{"issue":"2","key":"zoi260216r37","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/j.chest.2023.02.025","article-title":"The need and approach for critical assessment of extracorporeal membrane oxygenation candidacy decision-making: a call to action.","volume":"164","author":"Rubin","year":"2023","journal-title":"Chest"},{"issue":"9","key":"zoi260216r38","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1080\/17476348.2018.1506331","article-title":"The effect of obesity on lung function.","volume":"12","author":"Dixon","year":"2018","journal-title":"Expert Rev Respir Med"},{"issue":"9","key":"zoi260216r39","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1177\/0885066618801547","article-title":"Percutaneous cannulation for extracorporeal life support in severely and morbidly obese patients.","volume":"35","author":"Keyser","year":"2020","journal-title":"J Intensive Care Med"},{"issue":"1","key":"zoi260216r40","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s13613-018-0417-3","article-title":"Vascular complications in adult postcardiotomy cardiogenic shock patients receiving venoarterial extracorporeal membrane oxygenation.","volume":"8","author":"Yang","year":"2018","journal-title":"Ann Intensive Care"},{"issue":"9","key":"zoi260216r41","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.3390\/nu17091553","article-title":"Nutrition provision in pediatric extracorporeal membrane oxygenation: evidence, challenges, and clinical considerations.","volume":"17","author":"Mansour","year":"2025","journal-title":"Nutrients"},{"key":"zoi260216r42","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1370286","article-title":"Research progress on nutritional support in the neonatal and pediatric populations receiving extracorporeal membrane oxygenation.","volume":"11","author":"Zhang","year":"2024","journal-title":"Front Nutr"},{"key":"zoi260216r43","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2021.666464","article-title":"Nutrition in pediatric extracorporeal membrane oxygenation: a narrative review.","volume":"8","author":"Toh","year":"2021","journal-title":"Front Nutr"},{"issue":"1","key":"zoi260216r44","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1097\/MAT.0000000000001714","article-title":"Measuring the resting energy expenditure in children on extracorporeal membrane oxygenation: a prospective pilot study.","volume":"69","author":"Ewing","year":"2023","journal-title":"ASAIO J"},{"issue":"1","key":"zoi260216r45","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1002\/jpen.1032","article-title":"Impact of early initiation of enteral nutrition on survival during pediatric extracorporeal membrane oxygenation.","volume":"42","author":"Greathouse","year":"2018","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"7","key":"zoi260216r46","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1002\/jpen.1154","article-title":"Nutrition delivery during pediatric extracorporeal membrane oxygenation therapy.","volume":"42","author":"Armstrong","year":"2018","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"1","key":"zoi260216r47","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.jpedsurg.2014.10.030","article-title":"Enteral nutrition in neonatal and pediatric extracorporeal life support: a survey of current practice.","volume":"50","author":"Desmarais","year":"2015","journal-title":"J Pediatr Surg"},{"issue":"6","key":"zoi260216r48","doi-asserted-by":"publisher","first-page":"254","DOI":"10.4103\/jpcc.jpcc_57_24","article-title":"Nutrition in neonatal and pediatric patients on extracorporeal membrane oxygenation: a survey of current practice in the US and Canada.","volume":"11","author":"Furlong-Dillard","year":"2024","journal-title":"J Pediatr Crit Care"},{"issue":"7","key":"zoi260216r49","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1097\/MAT.0000000000001767","article-title":"Extracorporeal life support organization guidelines for the provision and assessment of nutritional support in the neonatal and pediatric ECMO patient.","volume":"68","author":"Lee","year":"2022","journal-title":"ASAIO J"},{"issue":"3","key":"zoi260216r50","first-page":"343","article-title":"Artificial intelligence assisted nutritional risk evaluation model for critically ill patients: integration of explainable machine learning in intensive care nutrition.","volume":"34","author":"Chen","year":"2025","journal-title":"Asia Pac J Clin Nutr"},{"key":"zoi260216r1","unstructured":"Malnutrition. World Health Organization. March 1, 2024. Accessed June 10, 2025. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/malnutrition"},{"key":"zoi260216r10","unstructured":"ELSO international summary of statistics. Extracorporeal Life Support Organization. October 24, 2025. Accessed November 7, 2025. https:\/\/www.elso.org\/registry\/internationalsummaryandreports\/internationalsummary.aspx"},{"key":"zoi260216r14","unstructured":"ELSO registry data definitions. Extracorporeal Life Support Organization. February 13, 2025. Accessed July 7, 2025. https:\/\/www.elso.org\/portals\/0\/files\/new%20registry%20elso%20registry%20data%20definitions%202025.pdf"},{"key":"zoi260216r17","unstructured":"Growth charts. Centers for Disease Control and Prevention. Reviewed September 22, 2024. Accessed May 5, 2025. https:\/\/www.cdc.gov\/growthcharts\/index.htm"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2847958\/antonmartin_2026_oi_260216_1776101094.81844.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T15:30:28Z","timestamp":1776699028000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2847958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":50,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.6162","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}