Hypocapnia and other ventilation-related risk factors for cerebral palsy in low birth weight infants
Hypocapnia and other ventilation-related risk factors for cerebral palsy in low birth weight infants
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DOI：
10.1203/00006450-200112000-00014
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发表时间：
2001-12-01
影响因子：
3.6
通讯作者：
Paneth, N
中科院分区：
文献类型：
--
作者：
Collins, MP;Lorenz, JM;Paneth, N
极低出生体重新生儿的通气管理模式，特别是医源性低碳酸血症，偶尔与围产期脑损伤有关。然而，这种关系尚未在大的代表性人群中进行探索。为了研究机械通气极低出生体重儿与低碳酸血症和其他通气相关变量的致残性脑瘫风险，我们对1984年中期至1987年出生于新泽西的1105名出生体重500-2000 g的新生儿进行了一项基于人群的前瞻性队列研究，其中，902名幸存者中的777名（86%）在2岁或更大时至少有一次神经发育评估。在777名评估的幸存者中，有657名（85%）在新生儿期获得了血气分析，其中400名接受了机械通气。低碳酸血症定义为新生儿期动脉Pco（2）水平累积暴露的最高五分位数< 35毫米汞柱。257例未通气新生儿中有6例（2.3%）诊断为致残性脑瘫，320例无低碳酸血症的通气新生儿中有30例（9.4%）诊断为致残性脑瘫，80例低碳酸血症的通气新生儿中有22例（27.5%）诊断为致残性脑瘫。另外两个致残性脑性瘫痪的危险因素被发现-高氧和通气时间延长。在多变量分析中，三个解释变量中的每一个都独立地导致致残性脑瘫的风险增加2- 3倍。这些风险是叠加的。尽管极低出生体重新生儿机械通气的持续时间可能代表疾病的严重程度，但低碳酸血症和高氧血症在很大程度上可通过辅助治疗来控制。避免动脉Pco（2），水平
Ventilatory management patterns in very low birth weight newborns, particularly iatrogenic hypocapnia, have occasionally been implicated in perinatal brain damage. However, such relationships have not been explored in large representative populations. To examine the risk of disabling cerebral palsy in mechanically ventilated very low birth weight infants in relation to hypocapnia and other ventilation-related variables, we conducted a population-based prospective cohort study of 1105 newborns with birth weights of 500-2000 g born in New Jersey from mid-1984 through 1987, among whom 777 of 902 survivors (86%) had at least one neurodevelopmental assessment at age 2 y or older. Six hundred fifty-seven of 777 assessed survivors (85%), of whom 400 had been mechanically ventilated, had blood gases obtained during the neonatal period. Hypocapnia was defined as the highest quintile of cumulative exposure to arterial Pco(2) levels < 35 nun Hg during the neonatal period. Disabling cerebral palsy was diagnosed in six of 257 unventilated newborns (2.3%), 30 of 320 ventilated newborns without hypocapnia (9.4%), and 22 of 80 ventilated newborns with hypocapnia (27.5%). Two additional ventilatory risk factors for disabling cerebral palsy were found-hyperoxia and prolonged duration of ventilation. In a multivariate analysis, each of the three ventilatory variables independently contributed a 2- to 3-fold increase in risk of disabling cerebral palsy. These risks were additive. Although duration of mechanical ventilation in very low birth weight newborns likely represents severity of illness, both hypocapnia and hyperoxia are largely controlled by ventilatory practice. Avoidance of arterial Pco(2), levels