Severe Intraventricular Hemorrhage in Extremely Premature Infants: Are high Carbon Dioxide Pressure or Fluctuations the Culprit?

Abstract

Objective This study aims to examine the association between measures of hypercapnia and fluctuation in Pco ₂ and severe intraventricular hemorrhage (IVH) and to evaluate the prevalence of hypercapnia, hypocapnia, and fluctuations in Pco ₂ in the initial 72 hours of life among premature infants.

Study Design Retrospective study of premature infants with birth weight < 1,250 g, who were receiving some respiratory support. All blood gases obtained in the first 3 days of life were collected. Univariate and multivariate analyses were performed to assess the association of hypercapnia, and fluctuations in Pco ₂ with severe IVH.

Result Our cohort included 285 patients, of whom 84% were intubated. Only 20% patients had all blood gases in the normocapnia range; 9% had at least 1 gas with hypercapnia; 51% had at least 1 gas with hypocapnia, and 20% patients had both hypercapnia and hypocapnia at different times. Infants with severe IVH (n = 41) had significantly higher peak Pco ₂ and greater fluctuations in Pco ₂ within a short interval, compared with those without severe IVH (n = 227). After controlling for gestational age, gender, antenatal steroid exposure, presence of hypercapnia, and Apgar score at 5 minutes, fluctuation in Pco ₂ remained significantly associated with severe IVH.

Conclusion Fluctuations in Pco ₂ within a short period may be more significantly associated with severe IVH than the mere presence of hypercapnia.

Keywords

intraventricular hemorrhage - hypercapnia - fluctuations in Pco ₂ - carbon dioxide - premature infants - cerebral blood flow

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