Extracorporeal membrane oxygenation (ECMO) is a therapy that ensures adequate tissue oxygen delivery in patients suffering cardiac and/or respiratory failure that are unresponsive to conventional therapy During ECMO, it is common to see a decrease in urine output that may be associated with acute renal failure. In this context, continuous renal replacement therapy (CRRT) should be considered. Our aim is to evaluate a pioneer experience in Latin America, related to the use of CRRT in a group of neonatal-pediatric patients during ECMO. We conducted a retrospective review of patients treated with ECMO at our institution between May 2003 and May 2005. Twelve infants were treated with ECMO, six of them also underwent CRRT. The main reasons for CRRT initiation were fluid overload and progressive azotemia. Observed complications were clots in the filter and excessive ultrafiltration. CRRT was successful in fluid management and solute clearance in all patients. Discharge survival rate was 83%, all of them with normal renal function. Concurrent CRRT with ECMO is technically feasible and efficacious in the management of fluid overload and solute clearance. We report the first experience with these therapies in a Latin American neonatal-pediatric ECMO program associated with the Extracorporeal Life Support Organization.

Chylothorax is a common complication following CDH repair. We have a low rate of this complication in our institution. Conservative management is an appropriate approach for all patients; OCT could be an alternative to avoid surgery. We did not find any predictive factors for chylothorax in our series.

The establishment of an ECMO program was associated with a significant increase in long-term survival for infants with CDH.

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Introduction.As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. Objective. To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. Population and Methods. All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. Results. A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98% of cases, and that an adequate analgesia was achieved in 92% of patients. Around 12% of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95% CI: 1.28-30.63; p = 0.023). Conclusions. In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.