Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. e583-e589 (doi:10.1542/peds.2008-1016)
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ARTICLE

Permissive Hypercapnia and Risk for Brain Injury and Developmental Impairment

Erika W. Hagen, PhDa, Mona Sadek-Badawi, MBBCHa, David P. Carlton, MDb and Mari Palta, PhDa

a Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
b Department of Pediatrics, Emory University, Atlanta, Georgia

OBJECTIVE. Permissive hypercapnia is a respiratory-care strategy that is used to reduce the risk for lung injury. The goal of this study was to evaluate whether permissive hypercapnia is associated with higher risk for intraventricular hemorrhage and early childhood behavioral and functional problems than normocapnia among very low birth weight infants.

METHODS. Very low birth weight infants from a statewide cohort were eligible for this study when they were born at <32 weeks' gestational age and survived at least 24 hours. Infants were classified as receiving a permissive hypercapnia, normocapnia, or unclassifiable respiratory strategy during the first 24 hours after birth according to an algorithm based on PCO2 values and respiratory-treatment decisions that were abstracted from medical charts. Intraventricular hemorrhage diagnosis was also abstracted from the medical chart. Behavioral and functional outcomes were assessed by parent interview at 2 to 3 years. Logistic regression was used to evaluate the relationship between intraventricular hemorrhage and respiratory strategy; ordinary linear regression was used to evaluate differences in behavior and function scores between children by respiratory strategy.

RESULTS. Infants who received a permissive hypercapnia strategy were not more likely to have intraventricular hemorrhage than those with normocapnia. There were no differences in any of the behavioral or functional scores among children according to respiratory strategy. There was a significant interaction between care strategy and 1-minute Apgar score, indicating that infants with lower Apgar scores may be at higher risk for intraventricular hemorrhage with permissive hypercapnia.

CONCLUSIONS. This study suggests that permissive hypercapnia does not increase risk for brain injury and impairment among very low birth weight children. The interaction between respiratory strategy and Apgar score is a potential worrisome exception to this conclusion. Future research should further evaluate the effect of elevated PCO2 levels among those who are sickest at birth.

Key Words: permissive hypercapnia • developmental follow-up • intraventricular hemorrhage • very low birth weight

Abbreviations: VLBW—very low birth weight • BPD—bronchopulmonary dysplasia • IVH—intraventricular hemorrhage • PIP—positive inspiratory pressure • CPAP—continuous positive airway pressure • OR—odds ratio • SNAP-II—Score for Neonatal Acute Physiology II • CI—confidence interval • RR—relative risk

Accepted May 23, 2008.


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need some clarifications
Abeer J. Hani
Pediatrics Online, 3 Oct 2008 [Full text]