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  • Original Article
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Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

Abstract

Objective:

To examine whether hypercapnia in very low birth weight (VLBW) infants during the first 3 days of life is associated with severe intraventricular hemorrhage (IVH).

Study design:

Retrospective cohort study of inborn VLBW infants between January 1999 and May 2004 with arterial access during the first 3 days of life. A multiple logistic regression analysis was used where IVH was dichotomized ((grades 0/1/2)=non-severe; (grades 3/4)=severe). Measures of hypercapnia were entered into the model to ascertain their association with severe IVH.

Results:

In total, 574 VLBW infants met entry criteria. Worst IVH grade was 0 in 400; 1: 54; 2: 42; 3: 47; and 4: 31 infants. The logistic regression model consisted of the following predictors of severe IVH: gestational age, gender, 1 min Apgar score (dichotomized into two groups: >3 vs 3), multifetal gestation, vasopressor use, and maximum PaCO2.

Conclusion:

In addition to traditional risk factors, it appears maximum PaCO2 is a dose-dependent predictor of severe IVH during the permissive hypercapnia era.

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References

  1. Perlman JM, Goodman S, Kreusser KL, Volpe JJ . Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med 1985; 312: 1353–1357.

    Article  CAS  Google Scholar 

  2. Pryds O, Greisen G, Lou H, Friis-Hansen B . Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation. J Pediatr 1989; 115: 638–645.

    Article  CAS  Google Scholar 

  3. Tsuji M, Saul JP, du Plessis A, Eichenwald E, Sobh J, Crocker R et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics 2000; 106: 625–632.

    Article  CAS  Google Scholar 

  4. Kaiser JR, Gauss CH, Williams DK . The effects of hypercapnia on cerebral autoregulation in ventilated very low birth weight infants. Pediatr Res 2005; 58: 931–935.

    Article  Google Scholar 

  5. Harper AM . Autoregulation of cerebral blood flow: influence of the arterial blood pressure on the blood flow through the cerebral cortex. J Neurol Neurosurg Psychiatry 1966; 29: 398–403.

    Article  CAS  Google Scholar 

  6. Häggendal E, Johansson B . Effects of arterial carbon dioxide tension and oxygen saturation on cerebral blood flow autoregulation in dogs. Acta Physiol Scand 1966; 66: 27–53.

    Article  Google Scholar 

  7. Kenny JD, Garcia-Prats JA, Hilliard JL, Corbet AJS, Rudolph AJ . Hypercarbia at birth: a possible role in the pathogenesis of intraventricular hemorrhage. Pediatrics 1978; 62: 465–467.

    CAS  PubMed  Google Scholar 

  8. Dykes FD, Lazzara A, Ahmann P, Blumenstein B, Schwartz J, Brann AW . Intraventricular hemorrhage: a prospective evaluation of etiopathogenesis. Pediatrics 1980; 66: 42–49.

    CAS  PubMed  Google Scholar 

  9. Cooke RWI . Factors associated with periventricular haemorrhage in very low birthweight infants. Arch Dis Child 1981; 56: 425–431.

    Article  CAS  Google Scholar 

  10. Thorburn RJ, Lipscomb AP, Stewart AL, Reynolds EOR, Hope PL . Timing and antecedents of periventricular haemorrhage and of cerebral atrophy in very preterm infants. Early Hum Dev 1982; 7: 221–238.

    Article  CAS  Google Scholar 

  11. Levene MI, Fawer CL, Lamont RF . Risk factors in the development of intraventricular haemorrhage in the preterm neonate. Arch Dis Child 1982; 57: 410–417.

    Article  CAS  Google Scholar 

  12. Szymonowicz W, Yu VYH, Wilson FE . Antecedents of periventricular haemorrhage in infants weighting 1250 g or less at birth. Arch Dis Child 1984; 59: 13–17.

    Article  CAS  Google Scholar 

  13. Ment LR, Duncan CC, Ehrenkranz RA, Lange RC, Taylor KJ, Kleinman CS et al. Intraventricular hemorrhage in the preterm neonate: timing and cerebral blood flow changes. Pediatrics 1984; 104: 419–425.

    Article  CAS  Google Scholar 

  14. van de Bor M, van Bel F, Lineman R, Ruys JH . Perinatal factors and periventricular-intraventricular hemorrhage in preterm infants. AJDC 1986; 140: 1125–1130.

    CAS  PubMed  Google Scholar 

  15. Wallin LA, Rosenfeld CR, Laptook AR, Maravilla AM, Strand C, Campbell N et al. Neonatal intracranial hemorrhage: II. Risk factor analysis in an inborn population. Early Hum Dev 1990; 23: 129–137.

    Article  CAS  Google Scholar 

  16. Miall-Allen VM, de Vries LS, Dubowitz LMS, Whitelaw AGL . Blood pressure fluctuation and intraventricular hemorrhage in the preterm infant of less than 31 weeks' gestation. Pediatrics 1989; 83: 657–661.

    CAS  Google Scholar 

  17. Levene MI, Shortland D, Gibson N, Evans DH . Carbon dioxide reactivity of the cerebral circulation in extremely premature infants: Effects of postnatal age and indomethacin. Pediatr Res 1988; 24: 175–179.

    Article  CAS  Google Scholar 

  18. Kaiser JR, Gauss CH, Williams DK . Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very low birth weight infants. J Pediatr 2004; 144: 809–814.

    CAS  PubMed  Google Scholar 

  19. Gannon CM, Wiswell TE, Spitzer AR . Volutrauma, PaCO2levels, and neurodevelopmental sequelae following assisted ventilation. Clin Perinatol 1998; 25: 159–175.

    Article  CAS  Google Scholar 

  20. Phillips BL, McQuitty J, Durand DJ . Blood gases: Technical aspects and interpretation In: Goldsmith JP, Karotkin EH, Barker S (eds). Assisted Ventilation of the Neonate. Second ed. W.B. Saunders Company: Philadelphia, 1988 p 476.

    Google Scholar 

  21. Mariani G, Cifuentes J, Carlo WA . Randomized trial of permissive hypercapnia in preterm infants. Pediatrics 1999; 104: 1082–1088.

    Article  CAS  Google Scholar 

  22. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R . New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119: 417–423.

    Article  CAS  Google Scholar 

  23. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529–534.

    Article  CAS  Google Scholar 

  24. Hosmer DW, Lemeshow S . Applied Logistic Regression. 2nd ed. Wiley, Inc.: New York, 2000.

    Book  Google Scholar 

  25. Skouteli HN, Kuban KCK, Leviton A, Brown ER, Krishnamoorthy KS, Pagano M et al. Arterial blood gas derangements associated with death and intracranial hemorrhage in premature babies. J Perinatol 1988; 8: 336–341.

    CAS  PubMed  Google Scholar 

  26. Erickson SJ, Grauaug A, Gurrin L, Swaminathan M . Hypocarbia in the ventilated preterm infant and its effect on intraventricular haemorrhage and bronchopulmonary dysplasia. J Paediatr Child Health 2002; 38: 560–562.

    Article  CAS  Google Scholar 

  27. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N et al. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics 2003; 111: e590–e595.

    Article  Google Scholar 

  28. Carlo WA, Stark AR, Wright LL, Tyson JE, Papile LA, Shankaran S et al. Minimal ventilation to prevent bronchopulmonary dysplasia in extremely-low-birth-weight infants. J Pediatr 2002; 141: 370–375.

    Article  Google Scholar 

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Acknowledgements

Dr Kaiser was supported by a National Institute of Neurological Disorders and Stroke Grant 1 K23 NS43185. Presented in part at the 2005 Pediatric Academic Society, Society for Pediatric Research meeting, Washington, DC, May 14–17, 2005.

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Correspondence to J R Kaiser.

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Kaiser, J., Gauss, C., Pont, M. et al. Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants. J Perinatol 26, 279–285 (2006). https://doi.org/10.1038/sj.jp.7211492

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