PaCO2 and Neurodevelopment in Extremely Low Birth Weight Infants
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Date
2009
Journal Title
Journal ISSN
Volume Title
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MOSBY-ELSEVIER
Abstract
Objective To determine the relationship between PaCO2 in the first 4 days of life and neurodevelopment at 18 to 22 months.
Study design Stepwise regression and exhaustive CHAID (Chi-squared Automatic Interaction Detector) analyses were done for neurodevelopmental impairment (NDI), mental developmental index (MDI), and psychomotor developmental index (PDI) using clinical variables in combination with the maximum (max), time-weighted average (avg), and max-minimum (max-min) PaCO2 in 400 infants of 401 to 1000 g birth weight (BW).
Results By regression, NDI predictors were male sex, non-Caucasian race, premature prolonged rupture of membranes (PPROM), lower BW, IVH 3 to 4, and lower 1-minute Apgar score. For lower MDI, predictors were male sex, non-Caucasian race, PPROM, IVH 3 to 4, sepsis, and higher max-min PaCO2. For lower PDI, predictors were male sex, PPROM, lower BW, IVH 3 to 4, sepsis, and higher avg PaCO2. By CHAID, the most important predictor of NDI was sex. For MDI, sex was most important followed by max-min PaCO2>42 mm Hg in boys. For PDI, IVH was most important, followed by max-min PaCO2>42 mm Hg for grade <= 2 IVH.
Conclusions Extreme fluctuations in PaCO2 and higher max PaCO2 are associated with worse neurodevelopmental outcomes and may indicate either a greater severity of illness or contribution of PaCO2 to pathophysiology of adverse neurodevelopment. (J Pediatr 2009; 155:217-21).
Study design Stepwise regression and exhaustive CHAID (Chi-squared Automatic Interaction Detector) analyses were done for neurodevelopmental impairment (NDI), mental developmental index (MDI), and psychomotor developmental index (PDI) using clinical variables in combination with the maximum (max), time-weighted average (avg), and max-minimum (max-min) PaCO2 in 400 infants of 401 to 1000 g birth weight (BW).
Results By regression, NDI predictors were male sex, non-Caucasian race, premature prolonged rupture of membranes (PPROM), lower BW, IVH 3 to 4, and lower 1-minute Apgar score. For lower MDI, predictors were male sex, non-Caucasian race, PPROM, IVH 3 to 4, sepsis, and higher max-min PaCO2. For lower PDI, predictors were male sex, PPROM, lower BW, IVH 3 to 4, sepsis, and higher avg PaCO2. By CHAID, the most important predictor of NDI was sex. For MDI, sex was most important followed by max-min PaCO2>42 mm Hg in boys. For PDI, IVH was most important, followed by max-min PaCO2>42 mm Hg for grade <= 2 IVH.
Conclusions Extreme fluctuations in PaCO2 and higher max PaCO2 are associated with worse neurodevelopmental outcomes and may indicate either a greater severity of illness or contribution of PaCO2 to pathophysiology of adverse neurodevelopment. (J Pediatr 2009; 155:217-21).
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Keywords
SEVERE INTRAVENTRICULAR HEMORRHAGE, PRETERM INFANTS, BRONCHOPULMONARY DYSPLASIA, HYPERCAPNIA, CHILDREN, LIFE