Acidemia versus Hypercapnia and Risk for Severe Intraventricular Hemorrhage

Michael Maurice Zayek; Wael Alrifai; Richard Marion Whitehurst Jr.; Kok Lim Kua; Anthony Martino; Fabien Gabriel Eyal

doi:10.1055/s-0033-1349896

American Journal of Perinatology, Table of Contents

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

¹Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama

,

Wael Alrifai

²Department of Pediatrics, University of South Alabama, Mobile, Alabama

,

Richard Marion Whitehurst Jr.

¹Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama

,

Kok Lim Kua

²Department of Pediatrics, University of South Alabama, Mobile, Alabama

,

Anthony Martino

³Division of Pediatric Neurosurgery, Department of Surgery, University of South Alabama, Mobile, Alabama

,

Fabien Gabriel Eyal

¹Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama

› Author Affiliations

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

Full Text

References

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