You are the physician on call for the extracorporeal membrane oxygenation (ECMO) service. There are 5 calls today, but only one machine and one technologist available. Which of the following patients is the most appropriate recipient of this service?

ECMO is a form of cardiopulmonary suppo that is useful in the setting of potentially reversible pulmonary or cardiac disease. Treatment of meconium aspiration syndrome, sepsis, pneumonia, and congenital diaphragmatic hernia (pre- or postoperatively) are thus appropriate uses. The technique is also applicable in some circumstances as a bridge to cardiac or lung transplantation since the outlook for survival is quite good if the child can be maintained in a good physiological state until donor organs are available. Hypoplastic lungs do not have enough surface area to perform adequate gas exchange and are unlikely to mature to a point where they can sustain life. Babies with hypoplastic lungs will be bypass-dependent for life and consequently are not candidates for institution of ECMO therapy.