Abstract
BACKGROUND: Intraventricular hemorrhage (IVH) remains a concern among very low birth weight infants (VLBWI). Several factors have been incriminated in the development of IVH. Although hypercapnia early in life has been associated with an increased risk of IVH, the effect of cumulative exposure to hypercapnia (CEH) on the risk and severity of IVH has not been explored.
OBJECTIVE: To determine whether CEH in the first week of life is associated with risk and/or severity of IVH in VLBWI.
METHODS: Infants with birth weight ≤ 1250g and survived for >7 days were included. Blood gas measurements during the first week of life and known risk factors for IVH were obtained from medical records. CEH was calculated as the sum of hours of infants' exposure to pCO2 > 45 mmHg. Levels of CEH were compared between infant groups (group 1: no or grade 1 IVH; group 2: grade 2-4 IVH) using t-test. A stepwise logistic regression (LR) analysis was used to adjust for confounding variables and to assess the effect of CEH on IVH.
RESULTS: A total of 103 VLBWI were included. Infants in group 2 were more likely to be male, had lower gestational age, illicit drug exposure in utero, maternal MgSO4, delivery room resuscitation, hypotension, pulmonary hemorrhage, pneumothorax, and higher mean levels of CEH at 3 and 7 days of life (p<0.05). There was a significant increase in the occurrence of IVH with increasing quartiles of CEH (Pearson correlation p<0.05), as well as a direct and positive correlation between severity of IVH and increasing quartiles of CEH (Kendall's tau-b correlation, p=0.025). Male gender (OR=3.3, 95% CI: 1.3 – 8.4, p=0.01), pneumothorax (OR=10.2, 95% CI: 1.9 – 55.2, p=0.007), and CEH in the first week of life (OR=1.8, 95% CI: 1.2 – 2.8, p=0.006) significantly increased the risk for developing IVH.
CONCLUSIONS: Cumulative exposure to hypercapnia during the first week of life is associated with increased risk and severity of IVH.
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Cortez, J., Chawla, S. & Kazzi, S. 7 Cumulative Hypercapnia and Risk of Intraventricular Hemorrhage Among Very Low Birth Weight Infants. Pediatr Res 60, 491 (2006). https://doi.org/10.1203/00006450-200610000-00029
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DOI: https://doi.org/10.1203/00006450-200610000-00029