Development of an Intelligent Clinical Decision Support System for Predicting One-Year CPAP Adherence in Patients with Obstructive Sleep Apnea: A Pilot Study.

As a critical cardiopulmonary replacement technology, extracorporeal membrane oxygenation (ECMO) can partially or completely replace cardiopulmonary function to maintain systemic oxygenation, and has become an important method for treating critically ill neonates unresponsive to conventional treatment (, ). According to the report of the Extracorporeal Life Support Organization (ELSO) (), neonates who received ECMO accounted for about 29.8% of all worldwide registered ECMO cases in 2020, offering a hospital discharge survival rate of 65.3%, indicating that ECMO has significant value in the treatment of neonatal critical illnesses such as severe respiratory distress syndrome and persistent pulmonary hypertension of the newborn. However, the application of ECMO in the more vulnerable preterm infant population has progressed slowly (, ). Preterm infants have immature organ development, especially those with birth gestational age <34 weeks and birth weight ≤2 kg. Not only is it difficult to establish vascular access due to their delicate blood vessels, but they also have an immature coagulation mechanism, which is prone to serious complications such as intracranial hemorrhage (ICH). Therefore, preterm infants were once considered a relative contraindication for ECMO application (, ). In addition, the types and progression of diseases in preterm infants are unique. Most existing ECMO indication and contraindication guidelines are only applicable to term infants, and also lack targeted standards. There is also no mature consensus on anticoagulation and coagulation management as well as prevention and control of neurological injury. These factors have jointly restricted the clinical application of ECMO in preterm infants (). Compared with the United States and European countries, where neonatal ECMO was first implemented clinically in 1975 and numerous registry-based retrospective cohort studies have been released over the past decades (, ), neonatal ECMO practice in China began far later, particularly for preterm infants. Only limited single-center case reports have been published, and systematic multi-center analyses are still lacking (, ). Optimized ECMO hardware and refined clinical techniques have substantially improved treatment outcomes for low-gestational-age and low-birth-weight preterm infants, highlighting an urgent need to reassess traditional contraindication criteria. Against this backdrop, the present study aimed to summarize clinical experience and prognostic outcomes of preterm infants receiving ECMO support via analysis of clinical data from the Pediatric Extracorporeal Life Support Alliance of China (PELSAC) database collected from January 2016 to November 2025. Our findings aim to furnish clinical evidence to broaden ECMO use in Chinese preterm infants and refine treatment protocols, ultimately improving preterm survival and lowering related mortality and morbidity.