Ulrich H Thome1, Orsolya Genzel-Boroviczeny2, Bettina Bohnhorst3, Manuel Schmid4, Hans Fuchs5, Oliver Rohde6, Stefan Avenarius7, Hans-Georg Topf8, Andrea Zimmermann9, Dirk Faas10, Katharina Timme11, Barbara Kleinlein12, Horst Buxmann13, Wilfried Schenk14, Hugo Segerer15, Norbert Teig16, Annett Bläser1, Roland Hentschel5, Matthias Heckmann17, Rolf Schlösser13, Jochen Peters12, Rainer Rossi11, Wolfgang Rascher8, Ralf Böttger7, Jürgen Seidenberg6, Gesine Hansen3, Maria Zernickel4, Harald Bode18, Jens Dreyhaupt19, Rainer Muche19, Helmut D Hummler4. 1. Division of Neonatology, University Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany. 2. Division of Neonatology, IS Dr. von Hauner University Children's Hospital, Ludwig Maximilian University of Munich, München, Germany. 3. Division of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany. 4. Division of Neonatology and Pediatric Critical Care, University Hospital for Children and Adolescents, University of Ulm, Ulm, Baden-Württemberg, Germany. 5. Division of Neonatology and Pediatric Critical Care, University Hospital for Children and Adolescents, Albert Ludwigs University Freiburg, Freiburg, Germany. 6. Division of Neonatology and Pediatric Critical Care, Elisabeth Children's Hospital, Klinikum Oldenburg, Medical Campus, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany. 7. Hospital for General Pediatrics and Neonatology, Otto von Guericke University Magdeburg, Magdeburg, Germany. 8. Division of Neonatology, University Hospital for Children and Adolescents, Friedrich-Alexander University Erlangen, Erlangen, Germany. 9. Mutter-Kind-Zentrum, Klinikum rechts der Isar, Technical University of Munich, München, Germany. 10. University Hospital for General Pediatrics and Neonatology, Justus Liebig University Giessen, Giessen, Germany. 11. Division of Neonatology, Hospital for Children and Adolescents, Vivantes-Hospital Neukölln, Berlin, Germany. 12. Hospital for Children and Adolescents, Children's Hospital of the Third Order, Munich, Germany. 13. Division of Neonatology, University Hospital for Children and Adolescents of the J.W. Goethe University Frankfurt/Main, Frankfurt am Main, Germany. 14. Hospital for Children and Adolescents, Central Hospital Augsburg, Augsburg, Germany. 15. St. Hedwig Hospital, University of Regensburg (H.S.), Regensburg, Germany. 16. Department of Neonatology and Pediatric Intensive Care, Katholisches Klinikum, Ruhr University Bochum, Bochum, Germany. 17. Division of Neonatology and Pediatric Critical Care, University Hospital for Children and Adolescents, Ernst Moritz Arndt University Greifswald, Greifswald, Germany. 18. Division of Neuropediatrics, University Hospital for Children and Adolescents, University of Ulm, Ulm, Germany. 19. Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
Abstract
BACKGROUND: Tolerating higher partial pressures of carbon dioxide (PCO2) in mechanically ventilated extremely low birthweight infants to reduce ventilator-induced lung injury may have long-term neurodevelopmental side effects. This study analyses the results of neurodevelopmental follow-up of infants enrolled in a randomised multicentre trial. METHODS: Infants (n=359) between 400 and 1000 g birth weight and 23 0/7-28 6/7 weeks gestational age who required endotracheal intubation and mechanical ventilation within 24 hours of birth were randomly assigned to high PCO2 or to a control group with mildly elevated PCO2 targets. Neurodevelopmental follow-up examinations were available for 85% of enrolled infants using the Bayley Scales of Infant Development II, the Gross Motor Function Classification System (GMFCS) and the Child Development Inventory (CDI). RESULTS: There were no differences in body weight, length and head circumference between the two PCO2 target groups. Median Mental Developmental Index (MDI) values were 82 (60-96, high target) and 84 (58-96, p=0.79). Psychomotor Developmental Index (PDI) values were 84 (57-100) and 84 (65-96, p=0.73), respectively. Moreover, there was no difference in the number of infants with MDI or PDI <70 or <85 and the number of infants with a combined outcome of death or MDI<70 and death or PDI<70. No differences were found between results for GMFCS and CDI. The risk factors for MDI<70 or PDI<70 were intracranial haemorrhage, bronchopulmonary dysplasia, periventricular leukomalacia, necrotising enterocolitis and hydrocortisone treatment. CONCLUSIONS: A higher PCO2 target did not influence neurodevelopmental outcomes in mechanically ventilated extremely preterm infants. Adjusting PCO2 targets to optimise short-term outcomes is a safe option. TRIAL REGISTRATION NUMBER: ISRCTN56143743. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
RCT Entities:
BACKGROUND: Tolerating higher partial pressures of carbon dioxide (PCO2) in mechanically ventilated extremely low birthweight infants to reduce ventilator-induced lung injury may have long-term neurodevelopmental side effects. This study analyses the results of neurodevelopmental follow-up of infants enrolled in a randomised multicentre trial. METHODS:Infants (n=359) between 400 and 1000 g birth weight and 23 0/7-28 6/7 weeks gestational age who required endotracheal intubation and mechanical ventilation within 24 hours of birth were randomly assigned to high PCO2 or to a control group with mildly elevated PCO2 targets. Neurodevelopmental follow-up examinations were available for 85% of enrolled infants using the Bayley Scales of Infant Development II, the Gross Motor Function Classification System (GMFCS) and the Child Development Inventory (CDI). RESULTS: There were no differences in body weight, length and head circumference between the two PCO2 target groups. Median Mental Developmental Index (MDI) values were 82 (60-96, high target) and 84 (58-96, p=0.79). Psychomotor Developmental Index (PDI) values were 84 (57-100) and 84 (65-96, p=0.73), respectively. Moreover, there was no difference in the number of infants with MDI or PDI <70 or <85 and the number of infants with a combined outcome of death or MDI<70 and death or PDI<70. No differences were found between results for GMFCS and CDI. The risk factors for MDI<70 or PDI<70 were intracranial haemorrhage, bronchopulmonary dysplasia, periventricular leukomalacia, necrotising enterocolitis and hydrocortisone treatment. CONCLUSIONS: A higher PCO2 target did not influence neurodevelopmental outcomes in mechanically ventilated extremely preterm infants. Adjusting PCO2 targets to optimise short-term outcomes is a safe option. TRIAL REGISTRATION NUMBER: ISRCTN56143743. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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: 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