Racial and Sex Disparities in Incidence, Risk Factors, and Outcomes of Neonatal Extracorporeal Life Support in the United States

The impact of race on extracorporeal life support (ECLS) availability, morbidity, and mortality remains poorly defined. We sought to define the impact of race/ethnicity, sex, and location on ECLS outcomes, and identify potential disparities that remain intact using a modern, inclusive cohort of neonates receiving ECLS in the United States. Data were extracted from the Children's Hospital Association Pediatric Health Information System (PHIS) database on neonates who received ECLS from January 1, 2010-December 31, 2020. Both adjusted and unadjusted regression models were fitted to study the association between neonatal ECLS outcomes and covariates. During the study period, 6,695 neonates from 47 hospitals met the inclusion criteria. Non-Hispanic White neonates (45%), males (57%), and hospitals in the Southern region (32%) compromised the largest proportions of ECLS cases and cardiac disease (44%) was the most common indication for ECLS. Hospital region was associated with ECLS duration with hospitals in the Midwest (median 6 days) and West (6 days) having significantly shorter courses than those in the Northeast (7 days) and South (7 days) (p < 0.01). Associations between race/ethnicity, sex, hospital region, and mortality were detected. Non-Hispanic Black neonates (35% mortality), males (37%), and neonates in the Midwest region (34%) experienced lower ECLS mortality rates (all p < 0.05).