Severe Intraventricular Hemorrhage in Extremely Premature Infants: Are high Carbon Dioxide Pressure or Fluctuations the Culprit?

Objective This study aims to examine the association between measures of hypercapnia and fluctuation in Pco(2) and severe intraventricular hemorrhage (IVH) and to evaluate the prevalence of hypercapnia, hypocapnia, and fluctuations in Pco(2) in the initial 72 hours of life among premature infants. Study Design Retrospective study of premature infants with birth weight < 1,250g, who were receiving some respiratory support. All blood gases obtained in the first 3 days of life were collected. Univariate and multivariate analyses were performed to assess the association of hypercapnia, and fluctuations in Pco(2) with severe IVH. Result Our cohort included 285 patients, of whom 84% were intubated. Only 20% patients had all blood gases in the normocapnia range; 9% had at least 1 gas with hypercapnia; 51% had at least 1 gas with hypocapnia, and 20% patients had both hypercapnia and hypocapnia at different times. Infants with severe IVH (n = 41) had significantly higher peak Pco(2) and greater fluctuations in Pco(2) within a short interval, compared with those without severe IVH (n = 227). After controlling for gestational age, gender, antenatal steroid exposure, presence of hypercapnia, and Apgar score at 5 minutes, fluctuation in Pco(2) remained significantly associated with severe IVH. Conclusion Fluctuations in Pco(2) within a short period may be more significantly associated with severe IVH than the mere presence of hypercapnia.