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

Abstract

OBJECTIVE. The goal was to test the hypothesis that extremes of Paco₂ during the first 4 days after birth are associated with severe intraventricular hemorrhage (grades 3 and 4).

METHODS. A single-center retrospective review of clinical and blood gas data in the first 4 postnatal days for 849 infants with birth weights of 401 to 1250 g was performed. The univariate and multivariate relationships of severe intraventricular hemorrhage with maximal and minimal Paco₂, Paco₂ averaged over time (time-weighted Paco₂), and measures of Paco₂ fluctuation (SD of Paco₂ and difference in Paco₂ [maximum minus minimum]) were assessed.

RESULTS. Birth weight (mean ± SD) was 848 ± 212 g, and the median gestational age was 26 weeks. Infants with severe intraventricular hemorrhage had higher maximal Paco₂ (median: 72 vs 59 mm Hg) and time-weighted Paco₂ (mean: 49 vs 47 mm Hg) values but lower minimal Paco₂ values (32 vs 37 mm Hg). High Paco₂, low Paco₂, SD of Paco₂, and difference in Paco₂ predicted severe intraventricular hemorrhage, but time-weighted average Paco₂ was not as predictive.

CONCLUSIONS. Both extremes and fluctuations of Paco₂ are associated with severe intraventricular hemorrhage. It may be prudent to avoid extreme hypocapnia and hypercapnia during the period of risk for intraventricular hemorrhage.