Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 1039 (doi:10.1542/10.1542/peds.2007-0353)

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LETTER TO THE EDITOR

Both Extremes of Arterial Carbon Dioxide Pressure and the Magnitude of Fluctuations in Arterial Carbon Dioxide Pressure Are Associated With Severe Intraventricular Hemorrhage in Preterm Infants

Jeffrey R. Kaiser, MD, MA
Division of Neonatology
Departments of Pediatrics and Obstetrics and Gynecology
College of Medicine
University of Arkansas for Medical Sciences
Little Rock, AR 72205

To the Editor.—

I read the recent article by Fabres et al¹ with great interest. The authors of the study observed that hypocapnia, extreme hypercapnia, and fluctuations of PaCO₂ in premature infants with birth weights of 401 to 1250 g during the first 4 days of life are associated with severe intraventricular hemorrhage (IVH). The authors correctly pointed out that avoiding extremes of PaCO₂ during the period when these infants are at highest risk for developing IVH may be prudent. I am pleased that their work nicely expands on the observations from my study group that hypercapnia during the first 3 days of life is associated with severe IVH in very low birth weight infants.²

Disturbed cerebral blood flow and cerebral autoregulation are considered to play important roles in the development of IVH.^3–5 With respect to the role that hypercapnia may play in the etiology of severe IVH, my study group was the first to show in premature infants during the first week of life that increasing PaCO₂ is associated with progressively impaired cerebral autoregulation.⁶ Thus, because PaCO₂ is an important regulator of cerebral blood flow,⁷ we suggest a plausible mechanism for the association of early hypercapnia and development for IVH.

I compliment Fabres et al,¹ because their work importantly adds to the burgeoning literature on the potential negative effects of extremes of PaCO₂ during the early neonatal period in extremely premature infants.

ACKNOWLEDGMENTS

This research was supported by National Institute of Neurological Disorders and Stroke grant 1 K23 NS43185.

REFERENCES

1. Fabres J, Carlo WA, Phillips V, Howard G, Ambalavanan N. Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants. Pediatrics. 2007;119 :299 –305[Abstract/Free Full Text]
2. Kaiser JR, Gauss CH, Pont MM, Williams DK. Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants. J Perinatol. 2006;26 :279 –285[CrossRef][Medline]
3. Perlman JM, Goodman S, Kreusser KL, Volpe JJ. Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med. 1985;312 :1353 –1357[Abstract]
4. Pryds O, Greisen G, Lou H, Friis-Hansen B. Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation. J Pediatr. 1989;115 :638 –645[CrossRef][Web of Science][Medline]
5. Tsuji M, Saul JP, du Plessis A, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics. 2000;106 :625 –632[Abstract/Free Full Text]
6. Kaiser JR, Gauss CH, Williams DK. The effects of hypercapnia on cerebral autoregulation in ventilated very low birth weight infants. Pediatr Res. 2005;58 :931 –935[CrossRef][Web of Science][Medline]
7. Kaiser JR, Gauss CH, Williams DK. Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very low birth weight infants. J Pediatr. 2004;144 :809 –814[Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kaiser, J. R. Search for Related Content PubMed PubMed Citation Articles by Kaiser, J. R. Related Collections Premature & Newborn Social Bookmarking                         What's this?