Neonatal hepatic failure for early-onset group B streptococcal sepsis successfully treated using hemoperfusion with Jafron cartridge during V-A ECMO support

IntroductionManagement of neonatal Group B Streptococcal (GBS) sepsis with multi-organ failure requires innovative approaches when conventional therapies prove insufficient.Case ReportA term neonate developed severe respiratory failure and septic shock from GBS infection, necessitating veno-arterial extracorporeal membrane oxygenation (V-A ECMO) initiation at 24 hours of life. During ECMO support, the patient developed hepatic dysfunction with severe hyperbilirubinemia (peak total/direct bilirubin: 36.9/31.6 mg/dL). A Jafron HA60 hemoadsorption cartridge was integrated into the ECMO circuit, resulting in a 38% bilirubin reduction within 24 hours. Despite complications including lung atelectasis, renal dysfunction, and nosocomial COVID-19, the patient was successfully decannulated after 15 days, extubated after 24 days, and discharged home after 48 days with normal neurological outcomes.DiscussionThis case highlights the application of hemoadsorption technology for managing hepatic failure in neonatal ECMO.ConclusionHemoadsorption therapy represents a promising adjunctive treatment for neonates with severe hyperbilirubinemia during ECMO support.