PaCO2 and neurodevelopment in extremely low birth weight infants.

Academic Article

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 < or = 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.
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    Keywords

  • Birth Weight, Carbon Dioxide, Continental Population Groups, Developmental Disabilities, Female, Fetal Membranes, Premature Rupture, Humans, Infant, Extremely Low Birth Weight, Infant, Newborn, Intracranial Hemorrhages, Male, Multivariate Analysis, Pregnancy, Psychomotor Performance, Sepsis, Sex Factors
  • Digital Object Identifier (doi)

    Author List

  • McKee LA; Fabres J; Howard G; Peralta-Carcelen M; Carlo WA; Ambalavanan N
  • Start Page

  • 217
  • End Page

  • 21.e1
  • Volume

  • 155
  • Issue

  • 2