Almost 12,000 children have undergone extracorporeal membrane oxygenation (ECMO) since it's inception in 1976. We present the first neonate referred for ECMO from the Republic of Ireland, This baby developed severe respiratory failure secondary to meconium aspiration syndrome and survived neurologically intact after 7 days of ECMO support, We describe the basic physiology, indications and current outcomes for neonatal ECMO. Although a national ECMO program may not be currently feasible, eligible babies should hale access to this life-saving treatment and safe means of transportation to nearby ECMO centres should be developed.