Influence of PCO2 Control on Clinical and Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants
Influence of PCO2 Control on Clinical and Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants
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DOI：
10.1159/000485828
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发表时间：
2018-01-01
期刊：
影响因子：
2.5
通讯作者：
Hummler, Helmut D.
中科院分区：
文献类型：
--
作者：
Thome, Ulrich H.;Dreyhaupt, Jens;Hummler, Helmut D.
背景：二氧化碳分压（PCO2）的水平或波动可能影响极低出生体重儿的结局。目的：在一项随机试验的探索性分析中，我们假设达到的PCO2值可能与显著结局相关。方法：在每个治疗日，将婴儿分为4组：相对低碳酸血症组、正常碳酸血症组、高碳酸血症组或波动性PCO2组。为了分析的目的，最终分配到一个组是根据婴儿在其中度过的天数最多的一组进行的。采用方差分析（ANOVA）、Kruskal-沃利斯检验、X-2检验和Fisher精确检验以及多元逻辑回归进行统计学分析。结果：在359名婴儿中，57名被归类为低碳酸血症，230名被归类为正常碳酸血症，70名被归类为高碳酸血症，2名被归类为波动性PCO2。高碳酸血症婴儿的平均气道压和吸入氧分数的平均乘积（MAP x FiO（2））较高。对于这一组，死亡率更高，中度/重度支气管肺发育不良（BPD）、坏死性小肠结肠炎（NEC）和神经发育不良的可能性也更高。多因素Logistic回归分析显示，BPD或死亡的风险增加与出生体重（p <0.001）和MAP x FiO（2）（p <0.01）相关。神经发育不良的发生率与出生体重（p <0.001）和脑室内出血（IVH; p <0.01）相关。结论：通过MAP x FiO（2）测量的出生体重和呼吸系统发病率是死亡或BPD和NEC的最佳预测因素，而神经发育不良与低出生体重和IVH相关。单变量模型还确定了PCO2。因此，高碳酸血症似乎反映了更大的疾病严重程度，这可能是导致结局差异的原因。(C)2018 S. Karger AG，巴塞尔
Background: Levels or fluctuations in the partial pressure of CO2 (PCO2) may affect outcomes for extremely low birth weight infants. Objectives: In an exploratory analysis of a randomized trial, we hypothesized that the PCO2 values achieved could be related to significant outcomes. Methods: On each treatment day, infants were divided into 4 groups: relative hypocapnia, normocapnia, hypercapnia, or fluctuating PCO2. Ultimate assignment to a group for the purpose of this analysis was made according to the group in which an infant spent the most days. Statistical analyses were performed with analysis of variance (ANOVA), the Kruskal- Wallis test, the X-2 test, and the Fisher exact test as well as by multiple logistic regression. Results: Of the 359 infants, 57 were classified as hypocapnic, 230 as normocapnic, 70 as hypercapnic, and 2 as fluctuating PCO2. Hypercapnic infants had a higher average product of mean airway pressure and fraction of inspired oxygen (MAP x FiO(2)). For this group, mortality was higher, as was the likelihood of having moderate/severe bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and poorer neurodevelopment. Multiple logistic regression analyses showed an increased risk for BPD or death associated with birth weight (p < 0.001) and MAP x FiO(2) (p < 0.01). The incidence of adverse neurodevelopment was associated with birth weight (p < 0.001) and intraventricular hemorrhage (IVH; p < 0.01). Conclusions: Birth weight and respiratory morbidity, as measured by MAP x FiO(2), were the most predictive of death or BPD and NEC, whereas poor neurodevelopmental outcome was associated with low birth weight and IVH. Univariate models also identified PCO2. Thus, hypercapnia seems to reflect greater disease severity, a likely contributor to differences in outcomes. (C) 2018 S. Karger AG, Basel