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ELECTRONIC ARTICLE:
Nehama Linder, Orli Haskin, Orli Levit, Gil Klinger, Tal Prince, Nora Naor, Pol Turner, Boaz Karmazyn, and Lea Sirota
Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study
Pediatrics 2003; 111: e590-e595 [Abstract] [Full text] [PDF]
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P3Rs published:

[Read P3R] low pCO2 and IVH
thorsten v stanley, wellington new zealand   (12 May 2003)
[Read P3R] Re: Hypocarbia and intraventricular hemorrhage
Nehama Linder, Gil Klinger   (19 May 2003)

low pCO2 and IVH 12 May 2003
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thorsten v stanley,
senior lecturer in paediatrics
wellington school of medicine,
wellington new zealand

Send letter to journal:
Re: low pCO2 and IVH

paedtvs{at}wnmeds.ac.nz thorsten v stanley, et al.

This paper contains much of interest. I am concerned readers may get the impression relative hypocarbia may be protective of IVH in these infants.

There is no difference in the mean pH in either group and we must presume the infants with the lower pCO2 must therfore have had a relatively greater metabolic acidosis.

The evidence suggests hypocarbia associated with alkalosis (i.e. hyperventilation)is deleterious.

It would be interesting to analyse the results with this in mind

Re: Hypocarbia and intraventricular hemorrhage 19 May 2003
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Nehama Linder,
Neonatologist
Schneider Children's Medical Center of Israel, Petach Tiqva, Israel,
Gil Klinger

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Re: Re: Hypocarbia and intraventricular hemorrhage

linderm{at}netvision.net.il Nehama Linder, et al.

18 May 2003

To the editor: We appreciate Dr. Stanley’s comments regarding the possible association between hypocarbia and a decreased risk of intraventricular hemorrhage (IVH).(1) While hypercarbia has been demonstrated to increase the risk of IVH, probably by a mechanism of increased cerebral blood flow,(2) the effect of relatively mild hypocarbia on cerebral vasculature has yet to be defined. Severe hypocarbia has been associated with an increased risk of IVH and/or periventricular leukomalacia,(3)but it is unknown what influence relatively mild hypocarbia has on IVH. We noted that PaCO2 was slightly higher in the IVH group than in the control group but pointed out that our results are insufficient to conclude that mild hypocarbia is protective of IVH. There was no difference between the IVH and control groups with respect to acidosis possibly because acidosis is routinely corrected. In summary, we cannot conclude that mild hypocarbia is protective. It would seem prudent to continue a policy of maintaining normocarbia until further evidence is available.

Sincerely, N. Linder G. Klinger

1. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N, Turner P, Karmazyn B, Sirota L. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: A retrospective case-control study. Pediatrics 2003;111:590-5 (electronic articles).

2. Wallin LA, Rosenfeld CR, Laptook AR, et al: Neonatal intracranial hemorrhage: II. Risk factor analysis in an inborn population. Early Hum Dev 1990;23:129-37.

3. Ericson SJ, Grauau A, Gurrin L, Swaminathan M. Hypocarbia in the ventilated preterm infant and its effect on intracranial haemorrhage and bronchopulmonary dysplasia. J Paediatr Child Health 2002;38(6):560-2.