The neonatal respiratory disorders most commonly treated with ECMO cause hypoxemic respiratory failure that is often complicated by persistent pulmonary hypertension of the newborn; such disorders include meconium aspiration syndrome, congenital diaphragmatic hernia, sepsis/pneumonia, primary persistent pulmonary hypertension, and air leaks.
Respiratory distress syndrome accounted for a significant number of ECMO cases in the 1980s but this number has declined with the introduction of exogenous surfactant treatment in 1990. Furthermore, the introduction of inhaled nitric oxide and high-frequency mechanical ventilator devices and strategies in the mid-1990s has been associated with a significant decline in number of neonatal respiratory failure cases receiving ECMO.
The peak number of neonatal respiratory ECMO cases reported to an international registry maintained by the Extracorporeal Life Support Organization was 1516 in 1992; there were 801 neonatal respiratory cases reported in 2011.
As a consequence, neonatal cases treated with ECMO are more often than not sicker than in the 1980s and 1990s, not responsive to advances in care (such as surfactant, inhaled nitric oxide, high-frequency ventilation, and gentle ventilation strategies), and have less frequently encountered disorders associated with hypoxemic respiratory failure such as surfactant protein deficiencies, alveolar capillary dysplasia, and pulmonary interstitial glycogenosis.