Hypocarbia and adverse outcome in neonatal hypoxic-ischemic encephalopathy
Athina Pappas, Seetha Shankaran, Abbot R Laptook, John C Langer, Rebecca Bara, Richard A Ehrenkranz, Ronald N Goldberg, Abhik Das, Rosemary D Higgins, Jon E Tyson, Michele C Walsh, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Alan H Jobe, Avroy A Fanaroff, Michele C Walsh, Deanne E Wilson-Costello, Nancy S Newman, Bonnie S Siner, Edward F Donovan, Kurt Schibler, Jean J Steichen, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, Michael C Cotten, Ricki F Goldstein, Kathy J Auten, Melody B Lohmeyer, Barbara J Stoll, Lucky Jain, Ira Adams-Chapman, Ellen C Hale, Linda L Wright, Rosemary D Higgins, Elizabeth M McClure, James A Lemons, Brenda B Poindexter, Anna M Dusick, Diana D Appel, Lucy C Miller, Leslie Richard, Kenneth W Poole, Abhik Das, Betty K Hastings, Jamie E Newman, Carolyn Petrie Huitema, David K Stevenson, Krisa P Van Meurs, Susan R Hintz, M Bethany Ball, Waldemar A Carlo, Myriam Peralta- Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Neil N Finer, Yvonne E Vaucher, Maynard R Rasmussen, David Kaegi, Kathy Arnell, Clarence Demetrio, Martha G Fuller, Chris Henderson, Wade Rich, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Dale L Phelps, Ronnie Guillet, Gary J Myers, Linda J Reubens, R Laptook, Pablo J Sanchez, R Sue Broyles, Roy J Heyne, Susie Madison, Jackie F Hickman, Gaynelle Hensley, Nancy A Miller, Jon E Tyson, Kathleen A Kennedy, Brenda H Morris, Pamela J Bradt, Esther G Akpa, Patty A Cluff, Claudia I Franco, Anna E Lis, Georgia E McDavid, Seetha Shankaran, Yvette R Johnson, Rebecca Bara, Geraldine Muran, Deborah Kennedy, William Oh, Abbot R Laptook, Betty R Vohr, Angelita M Hensman, Lucy Noel, Richard A Ehrenkranz, Patricia Gettner, Elaine Romano, Athina Pappas, Seetha Shankaran, Abbot R Laptook, John C Langer, Rebecca Bara, Richard A Ehrenkranz, Ronald N Goldberg, Abhik Das, Rosemary D Higgins, Jon E Tyson, Michele C Walsh, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Alan H Jobe, Avroy A Fanaroff, Michele C Walsh, Deanne E Wilson-Costello, Nancy S Newman, Bonnie S Siner, Edward F Donovan, Kurt Schibler, Jean J Steichen, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, Michael C Cotten, Ricki F Goldstein, Kathy J Auten, Melody B Lohmeyer, Barbara J Stoll, Lucky Jain, Ira Adams-Chapman, Ellen C Hale, Linda L Wright, Rosemary D Higgins, Elizabeth M McClure, James A Lemons, Brenda B Poindexter, Anna M Dusick, Diana D Appel, Lucy C Miller, Leslie Richard, Kenneth W Poole, Abhik Das, Betty K Hastings, Jamie E Newman, Carolyn Petrie Huitema, David K Stevenson, Krisa P Van Meurs, Susan R Hintz, M Bethany Ball, Waldemar A Carlo, Myriam Peralta- Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Neil N Finer, Yvonne E Vaucher, Maynard R Rasmussen, David Kaegi, Kathy Arnell, Clarence Demetrio, Martha G Fuller, Chris Henderson, Wade Rich, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Dale L Phelps, Ronnie Guillet, Gary J Myers, Linda J Reubens, R Laptook, Pablo J Sanchez, R Sue Broyles, Roy J Heyne, Susie Madison, Jackie F Hickman, Gaynelle Hensley, Nancy A Miller, Jon E Tyson, Kathleen A Kennedy, Brenda H Morris, Pamela J Bradt, Esther G Akpa, Patty A Cluff, Claudia I Franco, Anna E Lis, Georgia E McDavid, Seetha Shankaran, Yvette R Johnson, Rebecca Bara, Geraldine Muran, Deborah Kennedy, William Oh, Abbot R Laptook, Betty R Vohr, Angelita M Hensman, Lucy Noel, Richard A Ehrenkranz, Patricia Gettner, Elaine Romano
Abstract
Objective: To evaluate the association between early hypocarbia and 18- to 22-month outcome among neonates with hypoxic-ischemic encephalopathy.
Study design: Data from the National Institute of Child Health and Human Development Neonatal Research Network randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy were used for this secondary observational study. Infants (n = 204) had multiple blood gases recorded from birth to 12 hours of study intervention (hypothermia versus intensive care alone). The relationship between hypocarbia and outcome (death/disability at 18 to 22 months) was evaluated by unadjusted and adjusted analyses examining minimum PCO(2) and cumulative exposure to PCO(2) <35 mm Hg. The relationship between cumulative PCO(2) <35 mm Hg (calculated as the difference between 35 mm Hg and the sampled PCO(2) multiplied by the duration of time spent <35 mm Hg) and outcome was evaluated by level of exposure (none-high) using a multiple logistic regression analysis with adjustments for pH, level of encephalopathy, treatment group (± hypothermia), and time to spontaneous respiration and ventilator days; results were expressed as odds ratios and 95% confidence intervals. Alternative models of CO(2) concentration were explored to account for fluctuations in CO(2).
Results: Both minimum PCO(2) and cumulative PCO(2) <35 mm Hg were associated with poor outcome (P < .05). Moreover, death/disability increased with greater cumulative exposure to PCO(2) <35 mm Hg.
Conclusions: Hypocarbia is associated with poor outcome after hypoxic-ischemic encephalopathy.
Conflict of interest statement
The authors declare no conflicts of interest.
Copyright © 2011 Mosby, Inc. All rights reserved.
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Source: PubMed