Namasivayam Ambalavanan1, Waldemar A Carlo1, Lisa A Wrage2, Abhik Das3, Matthew Laughon4, C Michael Cotten5, Kathleen A Kennedy6, Abbot R Laptook7, Seetha Shankaran8, Michele C Walsh9, Rosemary D Higgins10. 1. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA. 2. Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA. 3. Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland, USA. 4. Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA. 5. Department of Pediatrics, Duke University, Durham, North Carolina, USA. 6. Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas, USA. 7. Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA. 8. Department of Pediatrics, Wayne State University, Detroit, Michigan, USA. 9. Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA. 10. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
Abstract
OBJECTIVE: To determine the association of arterial partial pressure of carbon dioxide PaCO2 with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. DESIGN: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). SETTING: Multiple referral neonatal intensive care units. PATIENTS: 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2 target 85-89% vs 91-95%) and ventilation strategies. MAIN OUTCOME MEASURES: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2 variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2 variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. RESULTS: sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2 and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2 category and SpO2 treatment group for sIVH/death, NDI/death or death. Max PaCO2 was positively correlated with maximum FiO2 (rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). CONCLUSIONS: Higher PaCO2 was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2 targets for high-risk infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: To determine the association of arterial partial pressure of carbon dioxide PaCO2 with severe intraventricular haemorrhage (sIVH), bronchopulmonary dysplasia (BPD), and neurodevelopmental impairment (NDI) at 18-22 months in premature infants. DESIGN: Secondary exploratory data analysis of Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). SETTING: Multiple referral neonatal intensive care units. PATIENTS: 1316 infants 24 0/7 to 27 6/7 weeks gestation randomised to different oxygenation (SpO2 target 85-89% vs 91-95%) and ventilation strategies. MAIN OUTCOME MEASURES: Blood gases from postnatal day 0 to day14 were analysed. Five PaCO2 variables were defined: minimum (Min), maximum (Max), SD, average (time-weighted), and a four level categorical variable (hypercapnic (highest quartile of Max PaCO2), hypocapnic (lowest quartile of Min PaCO2), fluctuators (hypercapnia and hypocapnia), and normocapnic (middle two quartiles of Max and Min PaCO2)). PaCO2 variables were compared for infants with and without sIVH, BPD and NDI (±death). Multivariable logistic regression models were developed for adjusted results. RESULTS: sIVH, BPD and NDI (±death) were associated with hypercapnic infants and fluctuators. Association of Max PaCO2 and outcomes persisted after adjustment (per 10 mm Hg increase: sIVH/death: OR 1.27 (1.13 to 1.41); BPD/death: OR 1.27 (1.12 to 1.44); NDI/death: OR 1.23 (1.10 to 1.38), death: OR 1.27 (1.12 to 1.44), all p<0.001). No interaction was found between PaCO2 category and SpO2 treatment group for sIVH/death, NDI/death or death. Max PaCO2 was positively correlated with maximum FiO2 (rs0.55, p<0.0001) and ventilator days (rs0.61, p<0.0001). CONCLUSIONS: Higher PaCO2 was an independent predictor of sIVH/death, BPD/death and NDI/death. Further trials are needed to evaluate optimal PaCO2 targets for high-risk infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Yvonne E Vaucher; Myriam Peralta-Carcelen; Neil N Finer; Waldemar A Carlo; Marie G Gantz; Michele C Walsh; Abbot R Laptook; Bradley A Yoder; Roger G Faix; Abhik Das; Kurt Schibler; Wade Rich; Nancy S Newman; Betty R Vohr; Kimberly Yolton; Roy J Heyne; Deanne E Wilson-Costello; Patricia W Evans; Ricki F Goldstein; Michael J Acarregui; Ira Adams-Chapman; Athina Pappas; Susan R Hintz; Brenda Poindexter; Anna M Dusick; Elisabeth C McGowan; Richard A Ehrenkranz; Anna Bodnar; Charles R Bauer; Janell Fuller; T Michael O'Shea; Gary J Myers; Rosemary D Higgins Journal: N Engl J Med Date: 2012-12-27 Impact factor: 91.245
Authors: Waldemar A Carlo; Ann R Stark; Linda L Wright; Jon E Tyson; Lu-Ann Papile; Seetha Shankaran; Edward F Donovan; William Oh; Charles R Bauer; Shampa Saha; W Kenneth Poole; Barbara Stoll Journal: J Pediatr Date: 2002-09 Impact factor: 4.406
Authors: Waldemar A Carlo; Neil N Finer; Michele C Walsh; Wade Rich; Marie G Gantz; Abbot R Laptook; Bradley A Yoder; Roger G Faix; Abhik Das; W Kenneth Poole; Kurt Schibler; Nancy S Newman; Namasivayam Ambalavanan; Ivan D Frantz; Anthony J Piazza; Pablo J Sánchez; Brenda H Morris; Nirupama Laroia; Dale L Phelps; Brenda B Poindexter; C Michael Cotten; Krisa P Van Meurs; Shahnaz Duara; Vivek Narendran; Beena G Sood; T Michael O'Shea; Edward F Bell; Richard A Ehrenkranz; Kristi L Watterberg; Rosemary D Higgins Journal: N Engl J Med Date: 2010-05-16 Impact factor: 91.245
Authors: Alan Leviton; Elizabeth N Allred; Robert M Joseph; T Michael O'Shea; Karl C K Kuban Journal: Respir Physiol Neurobiol Date: 2017-04-07 Impact factor: 1.931
Authors: Katherine P Sullivan; Heather O White; Lindsay E Grover; Jordi J Negron; Austin F Lee; Lawrence M Rhein Journal: Pediatr Res Date: 2021-01-19 Impact factor: 3.756
Authors: Massroor Pourcyrous; Sandeep Chilakala; Mohamad T Elabiad; Helena Parfenova; Charles W Leffler Journal: Pediatr Res Date: 2018-05-28 Impact factor: 3.756
Authors: Sie Kei Wong; M Chim; J Allen; A Butler; J Tyrrell; T Hurley; M McGovern; M Omer; N Lagan; J Meehan; E P Cummins; E J Molloy Journal: Pediatr Res Date: 2021-07-06 Impact factor: 3.953