{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:14:24Z","timestamp":1785500064704,"version":"3.56.0"},"reference-count":26,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,3,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To characterize the international experience concerning neonates with trisomy 21 (T21) managed with extracorporeal membrane oxygenation (ECMO), and to compare and contrast this group of patients to the neonatal ECMO population as a whole.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Data from the Extracorporeal Life Support Organization for newborn infants placed on ECMO between January 1984 and June 1999 were analyzed. Infants with T21 were compared with the group of infants without T21.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Fifteen thousand nine hundred forty-six infants, including 91 (n = 91) with the diagnosis of T21, were placed on ECMO for neonatal respiratory failure during the 14.5-year period. T21 infants were overrepresented in the ECMO population by several-fold when compared with the incidence of T21 in the general population. Eighty-seven of the 91 T21 infants were placed on ECMO after 1989. The distribution of primary diagnoses leading to ECMO differed between the groups (T21 vs non-T21): primary persistent pulmonary hypertension, 47.3% versus 13%; meconium aspiration syndrome, 23.1% versus 32.9%; sepsis, 7.7% versus 13.2%; congenital diaphragmatic hernia, 7.7% versus 19.9%; and respiratory distress syndrome, 3.3% versus 7.9%. Although survival to discontinuation of ECMO was similar in the 2 groups, likelihood of survival to discharge was decreased for T21 infants (65.9% vs 75.6%) because of increased post-ECMO mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>Extracorporeal Life Support Organization registry data suggests that T21 infants are at a significantly higher risk of being placed on ECMO for neonatal respiratory failure than the general population, perhaps as a result of delayed extrauterine pulmonary vascular adaptation, as manifested in the high rate of primary persistent pulmonary hypertension as the primary diagnosis. There may have been a shift in attitude regarding the use of ECMO in the T21 patient after 1989. Although most T21 patients placed on ECMO will survive, the prognosis is more guarded in this population when compared with all infants so managed. The long-term neurodevelopmental outcome of this group of T21 ECMO survivors is currently unknown.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.107.3.549","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:55:51Z","timestamp":1092441351000},"page":"549-552","source":"Crossref","is-referenced-by-count":30,"title":["International Experience With Trisomy 21 Infants Placed on Extracorporeal Membrane Oxygenation"],"prefix":"10.1542","volume":"107","author":[{"given":"W. 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Lancet"},{"key":"2021121009372654200_B13","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S0022-3476(95)70082-X","article-title":"Neurodevelopmental status at age five years of neonates treated with extracorporeal membrane oxygenation.","volume":"127","author":"Glass","year":"1995","journal-title":"J Pediatr"},{"key":"2021121009372654200_B14","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/j.1469-8749.1997.tb07463.x","article-title":"Severity of brain injury following neonatal extracorporeal membrane oxygenation and outcome at age 5 years.","volume":"39","author":"Glass","year":"1997","journal-title":"Dev Med Child Neurol"},{"key":"2021121009372654200_B15","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/0002-9149(72)90439-0","article-title":"Clinical aspects of congenital heart disease in mongolism.","volume":"29","author":"Sharer","year":"1972","journal-title":"Am J Cardiol"},{"key":"2021121009372654200_B16","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/0002-9149(83)90665-3","article-title":"Quantitative analysis of pulmonary vascular disease in simple cardiac anomalies with the Down syndrome.","volume":"51","author":"Yamaki","year":"1983","journal-title":"Am J Cardiol"},{"key":"2021121009372654200_B17","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0022-5223(19)34071-1","article-title":"Pulmonary vascular disease and operative indications in complete atrioventricular canal defect in early infancy.","volume":"106","author":"Yamaki","year":"1993","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021121009372654200_B18","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0022-5223(19)35606-5","article-title":"Down's syndrome, complete atrioventricular canal, and pulmonary vascular obstructive disease.","volume":"100","author":"Clapp","year":"1990","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021121009372654200_B19","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/j.1651-2227.1993.tb12763.x","article-title":"Pulmonary vascular resistance in complete atrioventricular septal defect. A comparison between children with and without Down's syndrome.","volume":"82","author":"Hals","year":"1993","journal-title":"Acta Paediatr"},{"key":"2021121009372654200_B20","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/S0022-3476(79)80718-0","article-title":"Hypertensive pulmonary vascular disease in Down syndrome.","volume":"95","author":"Wilson","year":"1979","journal-title":"J Pediatr"},{"key":"2021121009372654200_B21","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/S0002-9149(98)00012-5","article-title":"Size of ventricular structures influences surgical outcome in Down syndrome infants with atrioventricular septal defect.","volume":"81","author":"Minich","year":"1998","journal-title":"Am J Cardiol"},{"key":"2021121009372654200_B22","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0095-5108(18)30290-2","article-title":"The role of nitric oxide, endothelin, and prostaglandins in the transition of the pulmonary circulation.","volume":"22","author":"Ziegler","year":"1995","journal-title":"Clin Perinatol"},{"key":"2021121009372654200_B23","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1542\/peds.58.6.893","article-title":"The clinical course of cardiac disease in Down's syndrome.","volume":"58","author":"Greenwood","year":"1976","journal-title":"Pediatrics"},{"key":"2021121009372654200_B24","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/S0022-5223(19)35493-5","article-title":"Extracorporeal membrane oxygenation for the circulatory support of children after repair of congenital heart disease.","volume":"100","author":"Klein","year":"1990","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021121009372654200_B25","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1056\/NEJM198803173181105","article-title":"Neonatologist judge the \u201cBaby Doe\u201d regulations.","volume":"318","author":"Kopelman","year":"1988","journal-title":"N Engl J Med"},{"key":"2021121009372654200_B26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1542\/peds.98.1.149","article-title":"Ethics and the care of critically ill infants and children.","volume":"98","author":"American Academy of Pediatrics, Committee on Bioethics","year":"1996","journal-title":"Pediatrics"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/107\/3\/549\/891884\/549.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/107\/3\/549\/891884\/549.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:37:23Z","timestamp":1682746643000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/107\/3\/549\/66027\/International-Experience-With-Trisomy-21-Infants"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,3,1]]},"references-count":26,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2001,3,1]]},"published-print":{"date-parts":[[2001,3,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.107.3.549","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[2001,3,1]]}}}