A.S.P.E.N. Clinical guidelines: nutrition support of neonates supported with extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) utilizes a modified heart-lung machine with a membrane oxygenator in the setting of profound cardiorespiratory failure. ECMO has been used successfully in pediatric and adult applications, though the most frequent indication is neonatal respiratory failure in conditions such as persistent pulmonary hypertension, congenital diaphragmatic hernia, congenital heart disease, and meconium aspiration. ECMO use is associated with improved mortality, however the nutritional and metabolic burden in these children is considerable. ECMO does not provide a “metabolic rest.” Rather, neonates on ECMO have demonstrated some of the highest rates of protein catabolism reported. Appropriate provision of nutrition support in ECMO patients is predicated upon a clear understanding of the changes in their metabolism, metabolic reserves, and nutrition requirements. The purpose of this Clinical Guideline is to address the nutrition support of neonatal patients treated with ECMO.