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Original Article

Journal of Perinatology (2006) 26, 279–285. doi:10.1038/sj.jp.7211492; published online 23 March 2006

Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

J R Kaiser 1, C H Gauss 2, M M Pont 1 and D K Williams 3 1 Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

2 Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA

3 Division of Biostatistics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Correspondence: Dr JR Kaiser, Arkansas Children's Hospital, 800 Marshall Street, 512-5, Little Rock, AR 72202, USA. E-mail: kaiserjeffreyr@uams.edu

Received 18 October 2005; Revised 16 February 2006; Accepted 21 February 2006; Published online 23 March 2006.

Abstract
Objective:

To examine whether hypercapnia in very low birth weight (VLBW) infants during the first 3 days of life is associated with severe intraventricular hemorrhage (IVH).

Study design:

Retrospective cohort study of inborn VLBW infants between January 1999 and May 2004 with arterial access during the first 3 days of life. A multiple logistic regression analysis was used where IVH was dichotomized ((grades 0/1/2)=non-severe; (grades 3/4)=severe). Measures of hypercapnia were entered into the model to ascertain their association with severe IVH.

Results:

In total, 574 VLBW infants met entry criteria. Worst IVH grade was 0 in 400; 1: 54; 2: 42; 3: 47; and 4: 31 infants. The logistic regression model consisted of the following predictors of severe IVH: gestational age, gender, 1 min Apgar score (dichotomized into two groups: >3 vs 3), multifetal gestation, vasopressor use, and maximum PaCO2.

Conclusion:

In addition to traditional risk factors, it appears maximum PaCO2 is a dose-dependent predictor of severe IVH during the permissive hypercapnia era.

Keywords:
hypercapnia, intraventricular hemorrhage, carbon dioxide, very low birth weight infant

Reprinted with Permission