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Am J Perinatol 2014; 31(04): 345-352
DOI: 10.1055/s-0033-1349896
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acidemia versus Hypercapnia and Risk for Severe Intraventricular Hemorrhage

Michael Maurice Zayek
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Wael Alrifai
2   Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Richard Marion Whitehurst Jr.
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Kok Lim Kua
2   Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Anthony Martino
3   Division of Pediatric Neurosurgery, Department of Surgery, University of South Alabama, Mobile, Alabama
,
Fabien Gabriel Eyal
1   Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
› Author Affiliations
Further Information

Publication History

06 May 2013

05 June 2013

Publication Date:
19 July 2013 (online)

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Abstract

In extremely low birth weight (ELBW) infants, levels of hypercapnia (Paco 2) > 60 mm Hg are considered a risk factor for severe intraventricular hemorrhage (IVH). Since cerebral vasoreactivity depends on arterial pH (apH) rather than Paco 2, we hypothesize that the role of mild-to-moderate hypercapnia (45–60 mm Hg) in the occurrence of severe IVH is modulated by the metabolic component of acid–base status. ELBW infants (n = 580, born < 28 wk gestation, and BW < 1,000 g) were separated into “high-base deficit (BD)” (n = 291) and “low-BD” (n = 289) groups if infants' median BD were > 4 mEq/L or ≤4 mEq/L, respectively. Rates of severe IVH were higher in “high-BD” (16%) than “low-BD” (9%) group. Although adjusted risk for severe IVH increased with higher Paco 2 and higher BD, apH was the sole predictor of severe IVH. In ELBW infants, higher degree of acidemia, rather than hypercapnia per se, during the first 48 hours of life, is associated with higher occurrences of severe IVH.

Keywords

premature infants - extremely low birth weight infants - permissive hypercapnia - brain injury
 

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