3.3 Bleeding
Complications in the ECMO support are important predictors of poor outcomes. The most common complication was bleeding of this study. Sixteen cases experienced severe surgical site bleeding requiring explorations and 11 cases died. Neonates have small volume of circulating blood and immature blood coagulation mechanism, ECMO prefilling dilute the anticoagulant components and longer CPB time destroyed blood components. Improving supplement coagulation components and try to correct coagulation defects are very important[13]. There were four cases experienced severe GI bleeding and only one survived, and two cases with ECPR time greater than 30min before ECMO. GI bleeding resulted from infection, ischemia and hypoxia, feeding and blood flow to premature labor when patients under critical illness. Studies have shown that 90%-95% necrotizing enterocolitis (NEC) occurs in premature and low birth weight infants with a gestational age of less than 36weeks, which is the result of a combination of risk factors [17]. The literature believes that feeding factors (type, speed and concentration) are intrinsically linked to the occurrence of NEC, because the neonatal digestive system is immature and susceptible to ischemic injury; and digestive enzyme activity is low, which will eventually increase the incidence of NEC [18].