THERE IS no sicker cohort of infants in the neonatal intensive care unit than the group with primary or secondary persistent pulmonary hypertension of the newborn (PPHN). It is no wonder that neonatologists have rubbed Aladdin's lamp and wished for a therapy that offers a "cure" to this frustrating group of relatively large infants. The genie has given us extracorporeal membrane oxygenation (ECMO). However, we should heed the warning of the old aphorism: Be careful what you wish for; the wish may come true.
Since 1976, when Bartlett and coworkers1 first described four of 14 surviving pediatric patients treated with ECMO, there has been a slow, but increasing, movement to embrace this technology. Today, nearly 100 centers in this country offer ECMO technology and more than 8400 neonates have undergone bypass therapy. Survival rates are disease dependent, but the Extracorporeal Life Support Organization (ELSO) Registry in Ann Arbor, Mich,