Influence of PCO2 Control on Clinical and Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants
| Autor: | Rainer Muche, Orsolya Genzel-Boroviczény, Jochen Peters, Roland Hentschel, Benjamin Ackermann, Hans Fuchs, Harald Bode, Rainer Rossi, Gesine Hansen, Hans-Georg Topf, Oliver Rohde, Stefan Avenarius, Ulrich Thome, Jens Dreyhaupt, Dirk Faas, Rolf Schlösser, Manuel Schmid, Matthias Heckmann, Maria Zernickel, Norbert Teig, Jürgen Seidenberg, Ralf Böttger, Wolfgang Rascher, Katharina Timme, Andrea Zimmermann, Barbara Kleinlein, Helmut D. Hummler, B. Bohnhorst, Wilfried Schenk, Hugo Segerer, Horst Buxmann |
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| Rok vydání: | 2018 |
| Předmět: |
Pediatrics
medicine.medical_specialty business.industry Birth weight medicine.disease Bayley Scales of Infant Development respiratory tract diseases 03 medical and health sciences symbols.namesake Low birth weight 0302 clinical medicine Bronchopulmonary dysplasia 030225 pediatrics Fraction of inspired oxygen Pediatrics Perinatology and Child Health Necrotizing enterocolitis medicine symbols 030212 general & internal medicine Analysis of variance medicine.symptom business Fisher's exact test Developmental Biology |
| Zdroj: | Neonatology. 113:221-230 |
| ISSN: | 1661-7819 1661-7800 |
| Popis: | Background: Levels or fluctuations in the partial pressure of CO2 (PCO2) may affect outcomes for extremely low birth weight infants. Objectives: In an exploratory analysis of a randomized trial, we hypothesized that the PCO2 values achieved could be related to significant outcomes. Methods: On each treatment day, infants were divided into 4 groups: relative hypocapnia, normocapnia, hypercapnia, or fluctuating PCO2. Ultimate assignment to a group for the purpose of this analysis was made according to the group in which an infant spent the most days. Statistical analyses were performed with analysis of variance (ANOVA), the Kruskal-Wallis test, the χ2 test, and the Fisher exact test as well as by multiple logistic regression. Results: Of the 359 infants, 57 were classified as hypocapnic, 230 as normocapnic, 70 as hypercapnic, and 2 as fluctuating PCO2. Hypercapnic infants had a higher average product of mean airway pressure and fraction of inspired oxygen (MAP × FiO2). For this group, mortality was higher, as was the likelihood of having moderate/severe bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and poorer neurodevelopment. Multiple logistic regression analyses showed an increased risk for BPD or death associated with birth weight (p < 0.001) and MAP × FiO2 (p < 0.01). The incidence of adverse neurodevelopment was associated with birth weight (p < 0.001) and intraventricular hemorrhage (IVH; p < 0.01). Conclusions: Birth weight and respiratory morbidity, as measured by MAP × FiO2, were the most predictive of death or BPD and NEC, whereas poor neurodevelopmental outcome was associated with low birth weight and IVH. Univariate models also identified PCO2. Thus, hypercapnia seems to reflect greater disease severity, a likely contributor to differences in outcomes. |
| Databáze: | OpenAIRE |
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